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Second branchial cleft cyst
The vast majority (95%) of branchial cleft anomalies arise from the second cleft . At least three-fourths of these anomalies are cysts , which typically occur between 10 and 40 years of age, in contrast to fistulas or sinuses, which manifest most commonly during the 1st decade of life . No gender predilection has been reported .
Bailey classified second branchial cleft cysts into four types.
Most second branchial cleft cysts are located in the submandibular space. However, because of the anatomic relationship of the second branchial apparatus and the cervical sinus, they can occur anywhere along a line from the oropharyngeal tonsillar fossa to the supraclavicular region of the neck .
These cysts usually appear as painless, fluctuant masses in the lateral portion of the neck adjacent to the anteromedial border of the sternocleidomastoid muscle at the mandibular angle . The mass enlarges slowly over time and may become painful and tender if secondarily infected . In a young patient, a history of recurrent inflammation in the region of the mandibular angle is highly suggestive of a second branchial cleft cyst. If a fistula is present, the ostium is usually noted at birth just above the clavicle in the anterior neck .
Surgical excision is the recommended therapy for a branchial cleft anomaly because of the increased frequency of secondary infection.