- Human pathology

Home > F. Pathology by regions > Head and neck > Neck > branchial cleft remnants

branchial cleft remnants

Tuesday 24 August 2004

During the fifth week of fetal development, major head and neck structures are formed.

The five branchial arches (pharyngeal arches) (bands of tissue) are important structures that are formed. These branchial arches contain primitive connective tissue that becomes cartilage, bone, muscle and blood vessels.

Incomplete, failed or persistent embryonic development of these arches results in several anomalies or defects in the neck.

Two common congenital problems which can occur from this abnormal development are branchial cleft sinuses and branchial cleft cysts.

First branchial cleft anomalies are rare, but do occur as cysts that lie in front, behind, or below the earlobe or under the jaw. A first branchial sinus has an external opening below the jaw and above the hyoid bone (a bone present in the neck just above the voice box).

Second branchial cleft sinuses occur as sinus tracts with an opening on the skin of the neck during the first 10 years of life, and as cysts during the second 10 years. A skin tag or abnormal cartilage may occasionally be present at the opening of the sinus, and occasionally the tract may be felt as a band in the neck.

Third branchial cleft sinuses are extremely rare and are often located near the thyroid and along the front part of the muscle in the neck which attaches to the collar bone.

Fourth branchial cleft sinuses are also rare and are located low in the neck similar to the third cleft sinuses.


- branchial cleft fistula
- branchial cleft sinus

  • branchial external sinus
  • branchial internal sinus
    - branchial cleft cysts

Clinical synopsis

Infection and/or drainage from small openings on the neck are common signs of branchial cleft sinuses.

Branchial cleft cysts present as swelling in the neck.

At times the cysts or cartilage remnant is a small mass and removal is done to establish a diagnosis.

Drainage of saliva from a sinus on to the neck is unsightly and can cause chronic irritation of the skin. Removal will stop this problem.

Cysts and sinuses frequently get infected. Removal is performed to present this problem.

Though it happens rarely, branchial cleft remnants have been the site of development of malignant tumors in adults.

Complete surgical removal of branchial remnants should be performed.

Recurrence of the cyst or sinus is possible, and it is more common when the operation is done at the time of an active infection.

Developmental anomaly of fusion of branchial clefts and pouches ○ most second branchial cleft

Pathological synopsis

- Clinically present as lesions in anterolateral neck

  • cyst, sinus, fistula or skin tag
  • may also rarely occur in midline

- Lined by non-keratinizing squamous or respiratory type epithelium

  • most also have lymphoid tissue in wall
  • secondary inflammation and fibrosis

See also

- branchial clefts
- branchial arches