Branchial Cleft Abnormalities

What are the signs and symptoms of branchial cleft abnormalities (cysts/fistulas/sinuses)?

The signs and symptoms of branchial cleft cysts, fistulas or sinuses vary depending on the size and location of the abnormality. The most common signs and symptoms are:

• Small, usually painless, lump or mass on one or both sides of the neck
• A small opening in the skin on the side of the neck that drains fluid or mucus
• Pain, swelling, redness, warmth and fluid drainage if the branchial cleft cyst, fistula or sinus tract is infected.
• Trouble swallowing or breathing caused by a large branchial cleft abnormality

What tests are used to diagnose branchial cleft abnormalities (cysts/fistulas/sinuses)?

Your child’s medical provider performs a complete medical history and physical examination. Your child’s symptoms and location of the branchial cleft abnormality can affect how soon an abnormality is diagnosed. Some children are diagnosed as babies, but sometimes the abnormality may not be noticed until your child is older or an infection develops.

• Ultrasound of the neck may be the first imaging test to check for a branchial cleft anomaly.
• Computed tomography (CT) and/or magnetic resonance imaging (MRI) can help us assess the exact size and location of the cyst, fistula or sinus tract. MRI can also help us with surgical planning. Sometimes, contrast dye may be injected into the fistula or outside (external) part of the sinus tract to see where the fistula or tract connects to on the inside of the body.
• Fine-needle aspiration of the cyst, or a biopsy, may be recommended to evaluate the fluid and/or tissue from the abnormality under a microscope if the diagnosis is unclear.

Why choose us for diagnosing branchial cleft abnormalities (cysts/fistulas/sinuses)?

Your child’s multidisciplinary care team at Children’s Hospital Colorado includes:

• Physicians and surgeons
• Advance practice providers (nurse practitioners and physician assistants)
• Nurses
• Social workers
• Child life specialists
• Other pediatric professionals trained to diagnose, manage and treat pediatric branchial cleft abnormalities

We also use equipment and tools that are sized for children of all ages. Our team also uses techniques to help children understand and cope with their condition, diagnosis and treatment.

What to expect from testing for branchial cleft abnormalities (cysts/fistulas/sinuses)?

Your child’s diagnosis may include:

• History and physical examination: Your child’s medical provider performs a full medical history and physical examination.
• A neck ultrasound: We can perform this test while your child is awake. This should not be a painful test. Our radiology team is pediatric-trained, and our child life specialists help your child feel calm and prepared for the ultrasound.
• Computed tomography (CT) and/or magnetic resonance imaging (MRI). Our team works with your child to prepare them for a CT or MRI. If your child is very young or has trouble lying still, your child’s care team may recommend sedation or anesthesia for the study.
• Fine-needle aspiration of the cyst or a biopsy: We use this procedure to test fluid or tissue under a microscope. Your child may be awake or may receive sedation or anesthesia for these types of tests. Your child’s medical provider can discuss the options with you and your child to decide which option is right for you.

How do we diagnose branchial cleft abnormalities?

We can often diagnose branchial cleft abnormalities, especially external sinus tracts or fistulas, by physical examination alone. Your child’s medical provider may also use imaging tests to help make a diagnosis or plan for surgery.

How are branchial cleft abnormalities (cysts/fistulas/sinuses) treated?

• Antibiotics: If your child has an infected branchial cleft cyst, fistula or sinus tract, they may need antibiotics.
• Aspiration or incision and drainage (I&D): If the area is infected, your child’s medical provider may also recommend draining infected fluid using aspiration (with a small needle) or a small incision.
• Surgical removal: Your child may need surgery to remove the branchial cleft cyst, fistula or sinus tract. We may recommend surgery if your child has severe symptoms such as difficulty breathing or difficulty swallowing, frequent or repeated infections, or persistent drainage. Your child’s care team will discuss the details of the procedure with your family.

Why choose us for treatment of branchial cleft abnormalities (cysts/fistulas/sinuses)?

Children’s Hospital Colorado uses a multidisciplinary team approach to diagnose and treat children with complicated medical conditions. We consistently rank among the top pediatric hospitals in U.S. News & World Report.

Our faculty and staff are involved in pediatric research to bring the latest advances in research and technology to children and their families. We also provide resources for other healthcare professionals who diagnose and treat branchial cleft abnormalities.

Helpful resources

The National Center for Biotechnology Information conducts biomedical research and provides information on a range of medical conditions, including branchial cleft abnormalities such as branchial cleft cysts.