Branchial fistulas and cysts

Congenital cysts, fistulas, and sinuses in the neck are the result of embryonic structures that have not matured or have persisted aberrantly. 

The mature structures of the head and neck are derived from several branchial arches and their clefts. The clefts and pouches are gradually obliterated to form these structures. Abnormalities in the branchial cleft occur if this process is incomplete*.

Spontaneous mucoid drainage from the ostium along the edge of the sternocleidomastoid muscle usually announces its presence and initiates parental concern and the reason for the child's consultation*.

• • • Pathology of the 1st branchial arch: anomalies of the 1st branchial arch are rare and represent less than 1% of the malformations of the branchial cleft. Cysts are seen as swellings posterior or anterior to the ear or inferior to the earlobe in the submandibular region*.

    • Pathology of the 2nd branchial arch: anomalies of the 2nd branchial arch account for 95% of all branchial cleft anomalies. The ostium would be located along the anterior border of the sternocleidomastoid muscle*.
    • Pathology of the 3rd and 4th branchial arch: these are more common on the left side and present as a neck mass, recurrent abscess in the upper neck, or recurrent acute thyroiditis*.

Surgical excision should be considered from 3 years of age if the patient is asymptomatic. 

SCIENTIFIC EVIDENCE
* GW Holcomb, J Patrick Murphy, DJ Ostlie. Aschcraft´s Pediatric Surgery 6º Ed.
* P Mattei. Fundamentals of Pediatric Surgery.