Second branchial cleft anomaly

Cyst or Sinus or Fistula

Clinical features

• Sinus present in first decade

• Tiny pit in the skin anterior to the lower 1/3rd of Sternomastoid

• Palpable cord running upward in the neck from the ostium

• Milking – mucoid discharge

Cysts present later

Soft fluctuant mass deep to upper third of sternomastoid

Can get infected

TreatmentSurgical excision of the cyst or complete

sinus tract

If infected – Antibiotics +/- Needle aspiration followed by excision after an interval

To avoid Incision and drainage

Single or stepladder incisions for sinus/fistula

Hypoglossal, Glossopharyngeal nerves and internal & external carotid arteries

Remnants of the thyroglossal tract

Midline swelling – below, around and above the hyoid

Soft midline swelling

Moves up with swallowing and protuding tongue

May get infected Rupture/drainage

Fistula

Differential diagnosisDermoid cyst

Median ectopic thyroid

Lymphnodes

Thyroid

InvestigationUltrasound

Radionuclide thyroid scan

TreatmentInfected – Antibiotics +/- aspiration

Non infected cyst or fistula – complete surgical excision of the track – SISTRUNKS’ OPERATION

Removing central part of hyoid bone.