Case article · Clinical education
Management of a 40-Year-Old Male with an Infected Second Branchial Cleft Cyst
A 40-year-old male patient presents with a right submandibular mass that has been present for the past two months.
A 40-year-old male patient presents with a right submandibular mass that has been present for the past two months.
General Examination:
Unremarkable.
Systemic Examination:
No abnormalities noted.
Neck Examination:
A right submandibular mass measuring approximately 4 cm in diameter was identified. The mass was fixed, non-tender, and appeared to be in the submandibular region.
Neck Ultrasound Findings:
A well-defined, cystic mass was noted on the right side of the neck, located inferiorly to the low pole of the right parotid gland and partially covered by the anterior border of the upper part of the right sternocleidomastoid (SCM) muscle.
The mass was 49 × 33 × 28 mm in size, with a wall thickness of less than 3 mm. It appeared predominantly cystic, filled with internal echoes and debris, and showed hypovascularity. Fine internal septation was also noted. The surrounding tissue was compressed but otherwise normal. These findings were consistent with a complicated or infected second branchial cleft cyst.
CT Scan (with IV Contrast):
The scan revealed a well-defined cystic lesion anterior to the right sternocleidomastoid muscle, measuring 40 × 35 × 30 mm.
The lesion compressed the internal jugular vein and displaced the right submandibular gland. It showed a thick, enhancing wall with internal septation but no invasion into adjacent structures, suggesting an infected second branchial cleft cyst.
FNAC findings indicated features consistent with reactive lymphadenitis. No malignancy was identified. The recommendation was for total excision for definitive diagnosis.
This case presents a typical example of an infected second branchial cleft cyst, a congenital anomaly that results from incomplete obliteration of the second branchial cleft during embryogenesis. While these cysts are usually asymptomatic, infection or complications such as abscess formation can occur, presenting as an enlarging, tender mass.
Imaging studies like neck ultrasound and CT scans play an essential role in defining the cyst's location, size, and relationship with surrounding structures, and are crucial for preoperative planning. FNAC helps rule out malignancy and provides an initial diagnosis that aids in surgical management.
Surgical excision is the treatment of choice for branchial cleft cysts, and the Sistrunk operation, though typically used for thyroglossal duct cysts, is often adapted for cyst removal when appropriate. In this case, total excision of the cyst was performed, with no recurrence noted during follow-up.
