I saw one of these today: 
Background:
Branchial cleft cysts are congenital epithelial cysts, which arise on the lateral neck from a failure of obliteration of the second branchial cleft in embryonic development.
Phylogenetically, the branchial apparatus is related to gill slits. In fish and amphibians, these structures are responsible for the development of the gills, hence the name branchial (branchia is Greek for gills).
Pathophysiology:
At the fourth week of embryonic life, the development of 4 branchial (or pharyngeal) clefts results in 5 ridges known as the branchial (or pharyngeal) arches, which contribute to the formation of various structures of the head, neck, and thorax. The second arch grows caudally and ultimately covers the third and fourth arches. The buried clefts become ectoderm-lined cavities, which normally involute around week 7 of development. If a portion of the cleft fails to involute completely, the entrapped remnant forms an epithelium-lined cyst with or without a sinus tract to the overlying skin.
History:
A branchial cyst commonly will present as a solitary, painless mass in the neck of a child or young adult. A history of intermittent swelling and tenderness of the lesion during upper respiratory tract infection may exist. Discharge may be reported if the lesion is associated with a sinus tract.
In some instances, patients may present with locally compressive symptoms.
Family history may be present.
Physical:
Primary lesion: Branchial cysts are smooth, nontender, fluctuant masses, which occur along the lower one third of the anteromedial border of the sternocleidomastoid muscle between the muscle and overlying skin.
Secondary lesion: The lesion may be tender if secondarily inflamed or infected. When associated with a sinus tract, mucoid or purulent discharge onto the skin or into the pharynx may be present.
Surgical Care:
Surgical excision is definitive treatment for this condition.
A series of horizontal incisions, known as a stairstep or stepladder incision, is made to fully dissect out the occasionally tortuous path of the cyst.
Surgery is best delayed until the patient is at least age 3 months.
Definitive surgery should not be attempted during an episode of acute infection or if an abscess is present.
Surgical incision and drainage of abscesses is indicated if present, usually along with concurrent antimicrobial therapy.
Crap. I don't have an operating room here.
Background:
Branchial cleft cysts are congenital epithelial cysts, which arise on the lateral neck from a failure of obliteration of the second branchial cleft in embryonic development.
Phylogenetically, the branchial apparatus is related to gill slits. In fish and amphibians, these structures are responsible for the development of the gills, hence the name branchial (branchia is Greek for gills).
Pathophysiology:
At the fourth week of embryonic life, the development of 4 branchial (or pharyngeal) clefts results in 5 ridges known as the branchial (or pharyngeal) arches, which contribute to the formation of various structures of the head, neck, and thorax. The second arch grows caudally and ultimately covers the third and fourth arches. The buried clefts become ectoderm-lined cavities, which normally involute around week 7 of development. If a portion of the cleft fails to involute completely, the entrapped remnant forms an epithelium-lined cyst with or without a sinus tract to the overlying skin.
History:
A branchial cyst commonly will present as a solitary, painless mass in the neck of a child or young adult. A history of intermittent swelling and tenderness of the lesion during upper respiratory tract infection may exist. Discharge may be reported if the lesion is associated with a sinus tract.
In some instances, patients may present with locally compressive symptoms.
Family history may be present.
Physical:
Primary lesion: Branchial cysts are smooth, nontender, fluctuant masses, which occur along the lower one third of the anteromedial border of the sternocleidomastoid muscle between the muscle and overlying skin.
Secondary lesion: The lesion may be tender if secondarily inflamed or infected. When associated with a sinus tract, mucoid or purulent discharge onto the skin or into the pharynx may be present.
Surgical Care:
Surgical excision is definitive treatment for this condition.
A series of horizontal incisions, known as a stairstep or stepladder incision, is made to fully dissect out the occasionally tortuous path of the cyst.
Surgery is best delayed until the patient is at least age 3 months.
Definitive surgery should not be attempted during an episode of acute infection or if an abscess is present.
Surgical incision and drainage of abscesses is indicated if present, usually along with concurrent antimicrobial therapy.
Crap. I don't have an operating room here.
VIEW 3 of 3 COMMENTS
I seem to use them to take the place of family, sooner or later- it's easier that way. I can surround myself with people I actually WANT to be around.
Hope you're good, sir.