BACKGROUND: A branchial cleft cyst is a lump that develops in the neck or just below the collarbone. These abnormalities form during the development of the embryo and are most often found in children between the ages of 2 and 10. They may also form from fluid drained from a sinus.

Branchial cleft cysts are often first detected after an upper respiratory tract infection, which leaves them enlarged. The cysts may have an external opening from which liquid drains.

These cysts are often confused with another type of abnormality called preauricular sinus, or preauricular cyst. About 0.1 to 0.9 percent of people in the United States have this condition (Source: International Journal of Pediatric Otorhinolaryngology).

Like branchial cleft cysts, preauricular cysts develop during embryonic development -- specifically, during the sixth week. Unlike branchial cleft cysts, preauricular cysts don't normally involve branches of the facial nerve.

RISKS: Branchial cleft and preauricular cysts often become infected. When they do, they require antiobiotic treatment. When the problem becomes persistent or the cysts chronically drain, surgery is recommended.

Some research shows the cysts can increase the risk of cancer at their sites later in life. A study published in 2006 describes a 53-year-old man who developed cancer at the site of a branchial cleft cyst. The cancer received its own name -- branchial cleft carcinoma.

An older study set out to properly distinguish this kind of cancer from cancer of the lymph nodes and did so through radiologic evidence. Still, cancer arising from branchial cleft cysts is rare, and doctors mainly recommend removal of the cysts to prevent infection.

DIAGNOSIS: In addition to a physical exam and medical history, several procedures may be performed to determine the size and type of cyst a child has. CT scans help pinpoint the exact location and size of the cyst. A biopsy may rule out the possibility of cancer, and fine needle aspiration of the fluid in the cyst may provide further information.

SOLUTIONS: Complete removal of preauricular and branchial cleft cysts normally have good outcomes. The procedure is usually done as an outpatient surgery under general anesthesia, but an overnight stay may be needed if the operation is done deep in the neck. Surgical treatment for both preauricular sinus and branchial cleft cysts can put the facial nerve at risk of damage.

A new minimally invasive approach to the removal of these types of cysts reduces the risk of hitting that nerve, which controls the face and the tongue. The procedure also reduces the likelihood of scarring, which can not only be unsightly but also painful. Keloids, or excess growth of scar tissue, can form from surgical scars.

"The closer you get to the face, the higher incidence of keloid formation ... and keloid formation around the face is hard to treat and may need multiple therapies such as injections and re-surgery," Mitchell Austin, a pediatric otolaryngologist at Nemours Children's Clinic in Orlando, Fla., said.

FOR MORE INFORMATION, PLEASE CONTACT:
Mitchell Austin, MD
Nemours Children's Clinic
Orlando, FL
Public Relations: (407) 650-7462
http://www.nemours.org