Branchial fistulas (tracts) and cysts (called anomalies) are found in the neck and are composed of tissue trapped in the developing neck. These anomalies appear as a soft lump or draining opening on one side of the neck. They can appear in any age group yet are very common in the first decade of life. Because these anomalies develop in the growing embryo, any tract that forms in combination with a cyst follows a fairly predictable pattern. The tracts connect the cyst to the inside of the throat at a specific area. It is important to understand this relationship so that the entire tract can be excised and will not recur.
These lesions are first evaluated by physical examination. Magnetic Resonance imaging (MRI) is the imaging study that gives the best information regarding the extent and location of the cystic hygroma. X-rays and CT scans may also be used to help fully realize the extent of the cyst.
Branchial cysts are the most common of congenital neck masses. They are bilateral in about 2-3% of the cases. Usually, they do not appear at birth, but become noticeable much later in life. If they get infected, they may form a deep neck abscess or a draining fistula. The treatment of branchial cysts is surgical excision.
In children, The treatment of choice is complete surgical excision of the cyst . If branchial fistulas or cysts are noted in the neonatal period, surgery can be postponed until three to six months of age. This allows the child to grow and hopefully precedes a first upper respiratory infection which may lead to infection. If the abnormality is noted after six months of age, surgery should be done as soon as possible. The reason for this early excision is the high incidence of secondary infections of these lesions – probably at least 25% before definitive surgery.
- Remove drains when output decreases (typically one to two days).
- Advance diet as tolerated.
- Continue antibiotics postoperatively (as clinically indicated).
- Encourage topical wound care.
- Follow-up five to seven days for suture removal.
- Check pathology of specimen to assure that it is benign.