Type I second branchial cleft cyst in an adult patient

Branchial cleft anomalies are rare diseases of head and neck region. Second branchial cleft anomalies represent more than 95% of all branchial cleft anomalies. Second branchial cleft cyst is a benign developmental cyst due to the incomplete obliteration of pharyngeal cleft. A 46-year-old female patient reported to hospital with a complaint of swelling over the left side of the neck since 4 to 5 months. On clinical examination, swelling was seen below and behind the angle of mandible on the left side. The patient was evaluated using ultrasound and contrast enhanced computerized tomography (CECT) of neck which revealed second left bronchial cleft cyst/enlarged cystic lymph-node. Fine needle aspiration cytology of the swelling showed features of cystic lesion. Type-I branchial cleft cyst is a rare condition with a significant risk of misdiagnosis. To avert misdiagnosis and surgical complications, thorough investigation must be performed prior to surgical intervention.

Second Branchial Cleft Cyst: A Case Report

Objective: Branchial anomalies are congenital pathologies that are seen in the lateral region of the neck and are generally benign. The branchial clefts develop in the 2nd-7th weeks of fetal life as embryonal development. The branchial anomalies are caused by non-disappearance, abnormal development and, incomplete emerger of the branchial clefts and pockets during embryonal development. The branchial anomalies are generally seen as the cyst. The most common cyst was the second branchial cleft cyst with 95%. Their diameter is usually a few centimeters. Case: A 37-year old male patient was admitted to the hospital because of a swelling on the left side of his neck for four years. Physical examination revealed a mobile cystic mass in level 2 at the upper left jugular region of the neck. The cystic mass and the surrounding lymph nodes were excised and sent to the pathology laboratory. A cystic mass, approximately 5x4x3.5 cm in size, containing cystic areas was observed macroscopically. Microscopically, the cyst was lined with squamous epithelium and contained large lymphocyte groups in the subepithelial area. The case was reported as the branchial cleft cyst. Conclusion: Branchial cleft cysts should be excised before reaching large sizes, as they may cause pain and pressure on the surrounding tissue. In addition, it should be kept in mind that malignancy may develop from branchial cleft cysts, although rare.

Unusual Development of Second Branchial Cleft Cyst in an Adult after URTI: Diagnosis and Detailed Approach

Branchial cleft cyst is a congenital anomaly benign in nature. It usually appears in the lateral aspect of the neck and typically presents as a unilateral fluctuant mass. We present here a 30 years old adult who is previously healthy complaining of five years history of a left lateral neck swelling following an upper respiratory tract infection. Multiple aspirations were done but all resulted in recurrence of condition. Investigations have been done and a CT neck performed which showed a complicated second branchial cleft cyst. The definite treatment for branchial cleft cysts is surgery. He underwent surgical excision of the cyst with minimal scarring. This case is important due to the limited literature done in adults with branchial cleft cysts, in addition to highlighting the correct sequence of management when detecting a lateral cervical swelling.

Contents Vol. 32 no. 2 July– December 2017

EDITORIAL 4 Millenials in Medicine: Tradition and Disruption Lapeña JF ORIGINAL ARTICLES 6 Ehretia Microphylla (Tsaang Gubat) versus Loratadine as Treatment for Allergic Rhinitis: A Randomized Controlled Trial Umali FAC, Chua AH 11 Hungry Bone Syndrome (HBS) in Patients Operated for Primary Hyperparathyroidism (PHPT): A Six-Year Experience Padilla-Baraoidan RZM, Capuli-Isidro MJ, Cudal BIB, Embestro-Pontillas AA 17 Prevalence and Reasons for Non-Follow-Up of Newborns with “Refer” Results on Initial Hearing Screening Ong KMC, Cruz TLG, Grullo PER 22 Thyroid Gland Invasion in Laryngeal Carcinoma Vitamog MC, Castaneda SS 25 Risk Factors for Recurrent Papillary Thyroid Carcinoma Gloria JDL, Pontejos AQY, Grullo PER 30 An Initial Overview of Management and Treatment Outcomes for Head and Neck Hemangiomas Fernandez RU 34 Oral Propranolol Therapy for Benign Capillary Hemangiomas in a Series of Adult and Pediatric Patients Dimaguila GAC, Samson ES CASE REPORTS 38 Basal Cell Carcinoma, Odontogenic Cysts, Brain and Skeletal Abnormalities (Gorlin Goltz Syndrome) in a 46-Year-Old Woman Magbuhat DCD, Matsuo JMS, de la Cruz RAR 43 Unilateral Tonsilar Hypertrophy in a 4-Year-Old Girl with Focal Dermal Hypoplasia (Goltz Syndrome) Ong JEL, Barrientos CMAG, Cruz ETS 47 Late-onset Anterolateral Thigh Free Flap Failure in Buccal Carcinoma Reconstruction Mendoza DJC, Nieves CS, Castañeda SS 51 Supernumerary Nostril in a 15-Year-Old Girl Lluisma ACP FEATURED GRAND ROUNDS 55 A Second Branchial Cleft Cyst Presenting as a Dumbbell-Shaped Anterior Neck Mass Sunga ABG, Castañeda SS FROM THE VIEWBOX 58 Unilateral Horizontal Semicircular Canal Malformation Causing Recurrent Vertigo Yang NW UNDER THE MICROSCOPE 60 Sinonasal Tract Meningioma Rivera JP, Carnate JM LETTER TO THE EDITOR 62 Total Thyroidectomy From a Patient’s Perspective Villafuerte CV PASSAGES 65 Joseph Anthony R. Rivera, MD (1980-2016) Gelera JE