Branchial Clefts
Branchial cleft anomalies are congenital (present at birth) malformations that occur when the tissues in a baby’s neck and throat don’t develop normally during early fetal life. These anomalies can appear as cysts (fluid-filled sacs), sinuses (narrow tracts) or fistulas (abnormal passages that connect to the skin or throat). While present at birth, they often become noticeable later in childhood, especially when they become infected or drain fluid. These anomalies are a common cause of unexplained lumps or drainage in the neck area in children.
The most common signs and symptoms of a branchial cleft anomaly include a soft, painless lump on the side of the neck, repeated swelling in the same area or fluid or pus draining from a small opening near the ear, jawline or neck. Infections may cause the area to become red, tender and swollen.
There are four types of branchial cleft anomalies, based on where they occur along the neck:
First branchial cleft anomalies are rare and typically found near the ear or jaw. They may be mistaken for ear infections or cysts.
Second branchial cleft anomalies are the most common and often present as a lump or draining opening in the upper neck, just in front of the large neck muscle.
Third and fourth branchial cleft anomalies are much less common and usually appear lower in the neck or near the voice box (larynx) or thyroid gland.
Diagnosis usually involves a physical exam, followed by imaging studies like ultrasound, CT scan or MRI to determine the exact location and structure of the anomaly. The definitive treatment is surgical removal, which is typically recommended to prevent recurrent infections, drainage or other complications. Surgery is usually straightforward but must be done carefully to avoid nearby important nerves and structures in the neck.
With proper surgical management, branchial cleft anomalies are usually resolved without long-term problems. If your child has a recurring lump, swelling, or drainage in the neck or near the ear, please speak to your pediatrician about a referral or reach out to our team at ENT for Kids.