Excision Of Branchial Cleft Cyst/Fistula

Branchial Cleft Cysts and fistulas are congenital and arise during fetal development in the mother’s womb. The cysts can often remain unnoticed for years before they enlarge enough or get infected such that the patient and physician become aware of them, usually as a neck mass off to one side of the windpipe. Fistulas can very small but are typically seen near the base of the side of the neck at an early age. Removal of branchial cleft cysts and fistulas is recommended, typically after age 5, to avoid repeated infection or unsightly drainage. The procedure involves an incision across the side of the neck. In rare cases a second incision is required above the first to allow complete removal of the cyst or sinus tract and its roots and connections to the throat. After surgery, typically the patient will either go home or spend one night in the hospital. A drain is usually placed and will be removed a few days after surgery. Recurrence or reformation of the cysts is an uncommon but possible complication. Additional postop complications can include bleeding, injury to the nerves in the area possibly resulting in areas of numbness or permanent hoarseness, shoulder weakness, and in very rare cases possibly stroke or even death.

These risks and others were discussed with the patient or the patient’s parent or legal guardian (if the patient is a minor or is unable to give consent). Special attention was paid to the risks of bleeding, infection, and anesthesia. Bleeding and infection are not frequently encountered, and recurrence or the need for further surgery is uncommon. Unsightly scars are uncommon, but, if present, may require surgical revision. Multiple nerves can be closely associated with such cysts and fistulas. Injury or paralysis of these nerves is highly unlikely. Numbness of the skin surrounding the incision site is usually temporary but in rare cases, this sensation could be permanent.