From the Guidelines
Symptoms of a third branchial cleft anomaly typically include a painless neck mass or swelling, recurrent neck infections, abscess formation, or draining sinuses in the lower neck region, often accompanied by discharge from a small opening in the neck. According to the clinical practice guideline for evaluating neck masses in adults 1, it is essential to consider the possibility of malignant processes, such as papillary thyroid carcinoma, lymphoma, and oropharyngeal carcinoma, which can mimic branchial cleft cysts clinically and radiologically. Patients with third branchial cleft anomalies may experience:
- A painless neck mass or swelling located along the anterior border of the sternocleidomastoid muscle, often on the left side
- Recurrent neck infections, abscess formation, or draining sinuses in the lower neck region
- Discharge from a small opening in the neck, representing the external sinus opening
- Inflammation, tenderness, and increased size of the mass during upper respiratory infections
- Rarely, dysphagia (difficulty swallowing) or dyspnea (breathing difficulty) if the cyst becomes large enough to compress surrounding structures. The diagnosis and treatment of third branchial cleft anomalies should be approached with caution, considering the potential for malignancy, as highlighted in the guideline 1.
From the Research
Symptoms of Third Branchial Cleft Anomaly
The symptoms of a third branchial cleft anomaly can vary, but common presentations include:
- Recurrent neck abscesses 2, 3
- Suppurative thyroiditis 2
- Neck masses or cysts 4, 5
- Draining sinuses 6, 5
- Recurrent infections 5
Clinical Presentation
The clinical presentation of a third branchial cleft anomaly can be similar to other branchial cleft anomalies, with the most common presentation being a discharging sinus, followed by cystic neck swelling 6. However, third branchial cleft anomalies are rare and constitute less than 1% of all branchial cleft anomalies 4.
Diagnosis and Treatment
Diagnosis of a third branchial cleft anomaly can be made through a combination of clinical presentation, radiological investigations, and histopathological examination 2. Treatment typically involves complete surgical excision of the anomaly, which can be challenging in recurrent cases due to scarring and fascial plane disruption 4. A combined approach of endoscopy and lateral external cervical dissection can facilitate complete resection 4.