The aetiology of lateral cervical (branchial) cysts: past and present theories

Abstract

Four theories have been suggested to explain the aetiology of lateral cervical cysts. Ascherson (1832) suggested that the cysts arose due to incomplete obliteration of branchial cleft mucosa, which remained dormant until stimulated to grow later in life. His (1886) suggested these cysts were vestiges of the precervical sinus. Wenglowski (1912) believed lateral cervical cysts developed from the third pharyngeal pouch (thymopharyngeal duct).A number of investigators during the 19th century noted the close relationship between lateral cervical cysts and lymphoid tissue (Lucke, 1861). Luschka (1848) suggested that cystic degeneration of cervical lymph nodes was the mechanism by which lateral cervical cysts were formed. This theory received little support until King (1949) studied the histology of a large number of lateral cervical cysts and concluded that these cysts resulted from cystic transformation of cervical lymph nodes.The evidence for and against these theories of aetiology is discussed. The debate is centred on a study of 20 patients with lateral cervical cysts operated on in the Department of Otolaryngology, Bedford Hospital, between January 1986 and December 1991. In all twenty cases the wall of the cyst was found to be composed of lymphoid tissue, histologically identical to that present in lymph nodes. The mean age of presentation was 31 years, and in no case was a tract or cord found which connected the cyst to the skin or pharynx.The evidence strongly suggests that lateral cervical cysts develop from the cystic transformation of cervical lymph nodes. Mechanisms by which this may occur are discussed.

Branchial Cleft Cyst with Xanthogranulomatous Inflammation

“…The most important clinical differential diagnosis for our case included BCC and metastatic cystic squamous cell carcinoma;, although not always the case, the latter is more frequently observed in an older age group compared with the present patient [1][2][3][4].…”

“…The most favoured hypothesis is that these cysts are caused by the failure to obliterate the cervical sinus from the second branchial cleft remnant [2,3].…”

“…However their existence is controversial since these might be mimicked by metastatic cystic carcinomas, which are frequent lesions of the lateral neck in adults [1][2][3][4]. A malignant tumor, especially metastatic cystic squamous cell carcinoma, should always be considered in the differential diagnosis of a cystic lateral neck mass, particularly in patients older than 40 [1,2].…”

Rhytidectomy approach for surgical treatment of branchial cyst

“…From there, the incision is directed backwards and downwards following the postauricular hairline. Exposure afforded with this incision is wide enough for most of the benign tumours of the parotid gland.However, there is no mention in bibliography about using the facelift approach for the surgical treatment of cervical diseases.Devauchelle described a similar approach for mandibular reconstruction with microvascularized graft, avoiding unaesthetic cervical incisions [1].Branchial cysts and fistulae are pathologies frequently found in young people in which a cervicotomy approach may be quite conspicuous. These pathologies are usually located high and lateral in the neck, making them suitable for the rhytidectomy approach [2].…”

“…Devauchelle described a similar approach for mandibular reconstruction with microvascularized graft, avoiding unaesthetic cervical incisions [1].…”