BRANCHIAL CYST

BY
Dr Sowmya

(PG IN
ENT)
PRELIMINARY DATA
NAME : BABU

AGE : 23 YEARS

SEX : MALE

OCCUPATION : AGRICULTURAL
LABOURER

RESIDENT : SHADNAGAR, MBNR.

PRESENTING COMPLAINTS

SWELLING OVER THE

RIGHT LATERAL ASPECT
OF NECK SINCE TWO
MONTHS.
HISTORY OF PRESENT ILLNESS
Patient was apparently asymptomatic 2 months back
,then symptoms developed as small swelling over the
right lateral aspect of neck which is gradually
increasing and attained the present size.

Swelling is not associated with pain.

No history of hoarseness of voice, cough,

constitutional symptoms.
Past history- no history of similar complaints in the
past.
No history of trauma and foreign body ingestion in
the past.
Treatment history- Patient didn’t take any treatment
for the same complaints in the past.
Personal history- Mixed diet, bowel regular and
bladder normal, sleep and appetite normal.
Family history- nil significance.
EXAMINATION
General examination

Vitals – stable

Systemic examination
--CVS

--CNS
--RS
ENT and HEAD & NECK Examination
EXAMINATION OF NECK
INSPECTION :
 Single, diffuse, smooth swelling, size
approximately 10 X 8 cms present over the
right lateral aspect of neck.
 Extensions : Superiorly from right lobule
of ear to lower 1/3rd of sternocleidomastoid
muscle inferiorly. Medially 3 cm away from
midline to laterally 5 cms away from nape of
neck.
 Borders : Medial and inferior borders are
well defined and Lateral and superior
borders are diffuse.
 No visible pulsations over the swelling .
 Swelling is not moving with deglutition.
 No signs of inflammation.
PALPATION :
 Inspector y finding are confirmed with
respect to size and extension.
 No local rise of temperature.
 No tenderness.
 Consistency: cystic to firm.
 Skin over the swelling is pinchable .
 Swelling is not reducible and not
compressible
and fluctuations present over the
swelling.
 Trans illumination is negative.
 Movements : In both horizontal and
vertical directions are present.
 No other swellings are present
elsewhere in the body.
AUSCULTATION : No bruit
EAR : No abnormality detected.

NOSE : No abnormality detected.

THROAT : No abnormality detected.

 INVESTIGATIONS
 To confirm the diagnosis :

ULTRA SOUND NECK:

Ultra sound findings reveals large hypoechoic mass
noted infraauricular region extending anteriorly and
laterally to right side of neck.
? Lymphadenopathy

FNAC :
Cyto smear shows numerous nucleated and dyskeratotic
squames, degenerated squames, keratin debris,
lympocytes and pus cell
s/o branchial cyst.
To prepare the paitient for surgery :

BLOOD
HB -12gms,
RBS – 115 mg,
BU – 23 mg,
SC – 0.9 mg,
CT – 4.10 mins,
BT – 2 mins,
HIV & HBSAG – Non reactive

 URINE
Albumin and sugar : Nil.
CHEST X-RAY
Normal study.
 SURGICAL PROCEDURE
Incision : From the mastoid tip to
the level of hyoid bone.
 Skin flaps are elevated along
with platysma, sternoecleido
mastoid muscle retracted, swelling
indentified which is extended
superiorly to the base of skull and
posterolaterally to the vertebral
bodies, Anteromedially to the
submandibular gland, Posteriorly
mass was found to be attached to
the carotid sheath.
 While dissecting the
mass the part of sheath
adherent to the mass was
removed and vital
structures CA,IJV,VN
could be visualized
barely.
 Mass was separated from
all structures and excised
intoto, sent for HPE
GROSS APPEARENCE
HISTOPATHOLOGICAL REPORT
Multiple sections show cyst
lined by stratified squamous
epithelium,sub epithelial
fibrous stroma, linear
lymphoid cell aggregates.
 There are foci of
granulomatous response with
cholesterol clefts and multi
nucleated gaint cells.
 There is lymphnode with
reactive changes
DIFFERENTIAL DIAGNOSIS
Carotid body tumour
Tubercular lymphnodes
Metastatic lymphnodes
Cervical rib
Sternomastoid tumour
Lymphomas
Plunging ranula
Cystic hygroma
Branchial cyst :
It develops from the buried ectodermal pouch formed
under the second branchial arch which overlaps the
third & fourth and fuses with the fifth.
Though congenital, It does not appear before
adolescence and early adult life
Cyst present as a swelling in the upper part of the neck
anterior to SCM muscle
A painful increase in size at the time of URTI can
occur
THANQ