Cysts and Sinuses of the Head and Neck

An Infected Third Branchial Pouch Cyst presenting with Acute Stridor in an Infant

“…However, we did not end up in any procedure related complications in our case, which could be attributed to deferring the definitive surgery to a later date after the inflammation had subsided and the cyst size had decreased providing good and safe surgical planes of dissection. A diagnostic endoscopic assessment of the larynx and hypopharynx under general anaesthesia coupled well with the definitive surgery ruled out the internal communication and confirmed the diagnosis [2,3].…”

“…The cyst aspirate in our case did not yield any microbial growth which could be attributed to the broad spectrum antibiotic coverage given at a peripheral centre prior to referral to us. Imaging for these lesions range from a plain x-ray, barium swallow, ultrasonography, a radio-iodine scan, a contrast enhanced computed tomography (CT) and a gadolinium enhanced MRI of which MRI is the investigation of choice as it minimises ionising radiation exposure in children and provides excellent soft tissue detail [2,8]. Management guidelines for the branchial pouch anomalies differs between authors.…”

“…However, rare cases can safely be managed with high clinical suspicion as noted in our past experiences where a case of pseudo aneurysm presented mimicking an abscess [1]. Third and fourth branchial pouch anomalies are rare contributing to 1-2% of all branchial lesions and tend to present in early childhood [2]. Anomalies can be a sinus, a cyst or a fistula of which sinus is most common which has only one communication i.e., either with the skin or the pharynx.…”