Branchial cyst and thyroglossal cyst

2. Second branchial cleft anomaly
Cyst or Sinus or Fistula

3. 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

5. Cysts present later
Soft fluctuant mass deep to upper third of
sternomastoid
Can get infected

6. Treatment
Surgical excision of the cyst or complete sinus tract
If infected – Antibiotics +/- Needle aspiration
followed by excision after an interval
To avoid Incision and drainage

7. Single or stepladder incisions for sinus/fistula
Hypoglossal, Glossopharyngeal nerves and internal &
external carotid arteries

9. Remnants of the thyroglossal tract
Midline swelling – below, around and above the
hyoid

10. Soft midline swelling
Moves up with swallowing and protuding tongue
May get infected Rupture/drainage
Fistula

13. Differential diagnosis
Dermoid cyst
Median ectopic thyroid
Lymphnodes
Thyroid

14. Investigation
Ultrasound
Radionuclide thyroid scan

15. Treatment
Infected – Antibiotics +/- aspiration
Non infected cyst or fistula – complete surgical
excision of the track – SISTRUNKS’ OPERATION
Removing central part of hyoid bone.