Branchial anomalies result from improper development of the branchial apparatus during embryogenesis. They present as cysts, sinuses, or fistulas in the neck region due to failure of branchial clefts or pouches to regress normally. The definitive treatment is complete surgical excision to prevent recurrent infections while protecting important nerves like the spinal accessory and recurrent laryngeal. Second branchial cleft cysts are the most common type and manifest as neck masses anterior to the sternocleidomastoid muscle.

2. Branchial anomalies result from improper
development of the branchial apparatus

4. Fate of branchial arches

5. Fate of grooves and pouches

6. Fate of pouches

7. Anomalies

8. • Collection of fluid in an epithelium-lined sac .
• Formed when part of groove or pouch separated and fail to resorb .
• lined by :
• Contain straw-coloured fluid in which cholesterol crystals are found
• Squamous epithelium .
• Respiratory epithelium.
• 80% have lymphoid tissue in their wall .

9. :
 Represent persistence of both the cleft and the
corresponding pouch forming a communication that
is epithelial lined.
 The fistula lies caudal to the structures derived from
that particular arch and connects the skin to the
foregut.
 Lined by stratified squamous ,columnar , or ciliated
epithelium .

10.  Blind-ended track leading from an epithelial
surface into deeper tissues (partial fistula)
 Occur when groove or pouch fails to resorb

11. Diagnosis
• Upper airway endoscopy
• Pharyngeal opening
• Tonsillar fossa
• Pyriform sinus
• FNAC
• To clarify the diagnosis
• To rule out metastatic CA
• Ultrasound
• Round mass with uniform low echogenicity and lack of internal
septations

12. • Diagnosis
CT scan
• is first choice investigation
• Homogeneous lesion with low attenuation centrally and a smooth
enhancing rim
MRI
• Hypointense on T1 and hyperintense on T2
Fluroscopic or CT fistulography
• Inject radioopac dye into the fistula or sinus to delineate course
Barium swallow Esophageography
• for 3rd and 4th anomalies

13. Treatment
• The definitive treatment is complete surgical excision.
• Time for surgery
• Early resection to prevent recurrent infections
• Acute infection
• Systemic antibiotics first
• Incision and drainage
• Complete resection after resolution

14.  Can present as cysts, sinuses or fistulae located
between the EAC and the submandibular area.
 Represent 1% of all branchial anomalies
 Female > male
 Involve EAC or occasionally, the middle ear
 Course Close to parotid gland ,superficial lobe.

15. Symptoms:
 Otorrhea
 Parotid swelling
 Mandible pit discharge
 Unilateral facial palsy
Two types :

16. • Ectodermally derived
• Duplication of the external
auditory canal (EAC).
• immediately anterior ,inferior or
posterior to the pinna
• course lateral to the facial nerve,
.

17. • Ectodermal and mesodermal
derived tissues
• Terminate in EAC
• Behind or below the mandible
• Always suprahyaoid
• pass medial to the facial nerve
• More common than type I

20. Treatment
• Standard cervico-mastiod-facial parotidectomy incision
with facial nerve dissection and superficial
parotidectomy.
• Lacrimal probes can help locate tract

21. • Most common and represent 90-95% of branchial
anomalies.
• Cyst >fistula
• Cysts manifest as smooth , soft masses in the lateral
neck located anterior and deep to SCM.
• Fistulae tend to manifest as recurrent neck infections
following URTI

22. • Mostly diagnosed at 2nd
and 3rd decade
• Enlarged after URTI
• Can cause pressure
symptoms
• Commonly along the
anterior border of SCM.
• 4 types :

23. Types of 2nd BCC

24. • Mostly diagnosed in
infants
• Present with chronic
discharge along anterior
border of SCM .

25. TRACT

27. Treatment
• Transverse incision over skin fold
• Transvers elliptical incision made around the external opening and the
tract identified

28. Treatment
• surgeon must dissect around the cyst bed to exclude
associated fistula or tract
• Exploration of associated tract with complete excision
• Monofilament or probe to cannaulate the fistula tract
• Finger assisted to identify internal opening in tonsillar
fossa

29. Treatment
• The tract must be carefully ligated and divided at its entry
into the fossa
• The spinal accessory, hypoglossal, and vagus nerves must
identified to be protected from injury during the dissection.
• Cysts lying medial to carotid sheath are more easily
approached trans-orally

30. • Very Rare
• Mid or lower anterior border of SCM and at the level of
superior pole of thyroid
• Internal Opening to pyriform fossa
• This anomaly is also closely related to the thyroid gland,
which
when inflamed, may cause thyroiditis.
• Enlarged rapidly after URTI

33. • Extremely rare
• A lateral cervical cyst with an internal Opening in
the pyriform sinus is a common occurrence .
• mostly in children
• In neonatal :present as lateral neck mass or abscess
with obstructive airway symptoms
• In children or adult: recurrent lateral neck abscess
and recurrent suppurative thyroiditis .

36. Treatment
 External approach
 Excision of the tract with endoscopic assissted cannaulation.
 Ligation and dividing the tract
 Ipsilateral hemithroidectomy with partial resection of thyroid
cartilage for 4th pouch anomaly
 Internal approach
 Endoscopic electric cauterization
 Endoscopic chemical cauterization with silver nitrate

37.  Permanent recurrent laryngeal nerve palsy.
 Post operative pharyngocutaneous fistula
 Hypoglossal nerve palsy.
Complications