Friday, April 28, 2017

See also: Branchial Cleft Fistula First Arch Case Example

Overview

  • A congenital cyst that presents in close relation to the parotid region, facial nerve, and external auditory canal - a remnant of the 1st branchial cleft (Mehmi et al. 2019)
  • Typically located in the periauricular area (Fastenberg et al. 2016)
  • Work type 1 cysts contain only ectoderm and are located preauricularly, tracking anteriorly/medially to the external auditory canal (Coste et al. 2023)
  • Work type 2 cysts contain both ectoderm and mesoderm and are located at the angle of the mandible or submandibular region (Coste et al. 2023)
  • Rare, with type II cysts more common than type I (Coste et al. 2023)
  • On exam, typically smooth, non-tender, and fluctant mass
    • Otologic exam is important as there may be a connection to the middle or external ear (Coste et al. 2023)
  • Most presentations occur in the first two decades of life (Mehmi et al. 2019), consider in the setting of recurrent parotid infections

Radiologic Findings

  • On CT: Low density or isodense (if infected) without contrast; with contrast non-enhanching or mildly rim enhancing - stranding and enhancement if infected
  • On MR: low signal on T1; high signal with potential sinus tract on T2; T1 post-contrast will be low signal unless recent or current infection
CT with Contrast
1stBCC_CT_0721

 

T2-weighted MR
1stBCC_T2_0721

References

Mehmi N, Kumar R, Sagar P, Singh CA, Kumar R, Thakar A, Sharma SC. Importance and Impact of Appropriate Radiology in the Management of Branchial Cleft Anomalies. Indian J Otolaryngol Head Neck Surg. 2019 Oct;71(Suppl 1):953-959. doi: 10.1007/s12070-019-01634-w. Epub 2019 Mar 23. PMID: 31742101; PMCID: PMC6848690.

Coste AH, Lofgren DH, Shermetaro C. Branchial Cleft Cyst. 2023 Jun 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29763089.

Fastenberg J, Nassar M. First Branchial Cleft Cyst. N Engl J Med. 2016 Oct 20;375(16):e33. doi: 10.1056/NEJMicm1503044. PMID: 27797306.