Pharyngeal branchial cyst: magnetic resonance findings

Surgical Technique of Transoral Marsupialization for the Treatment of Nasopharyngeal Branchial Cysts

Objectives

Nasopharyngeal branchial cysts (NBCs) are derived from a remnant of the branchial apparatus and originate from the lateral wall of the nasopharynx. Total excision of these cysts was the standard treatment in the past. We present a simpler and less invasive approach for NBC treatment, involving marsupialization, and report on its effectiveness and advantages.

Methods

The surgical approach was transoral. A circular incision 2 to 3 cm in diameter was made directly through the inferior wall of the cyst. After the NBC was drained, its opening was widened with scissors. A disk of oropharyngeal mucosa and the connecting inferior wall of the cyst were excised together. The cut edges of the inner lining of the cyst and the oropharyngeal mucosa were approximated with sutures.

Results

All 4 patients were female. One patient was observed because of poor cardiovascular health, the 3 patients who were managed surgically underwent successful transoral cyst marsupialization. The mean follow-up period was 21 months (range, 8 to 40 months). No obvious postoperative complication or recurrence was noted.

Conclusions

Transoral marsupialization is a simple, effective, and less invasive method for treatment of NBCs.

A branchial cyst of the pyriform fossa transoral laser resection: a case report

Pyriform sinus malformations represent rare third and fourth branchial anomalies. Fistulae at the latter site were initially described and make up less than 1 % of all brachial anomalies. They may be discovered incidentally, or may present as a neck mass with recurrent infection, dysphagia, or airway compromise, and can be an unusual cause of dysphonia in infant and children. Here, we present a case of third branchial cyst located in pharyngeal wall of the left pyriform sinus which presented with dysphonia since birth in a 6-year-old girl. Transoral CO2 laser excision was carried out successfully with no communicating tract. The patient's dysphonia showed progressive regression at 1-year follow-up. Third branchial cyst in the left pyriform sinus (Bailey's type IV) is an unusual cause of dysphonia in pediatric. Our present case report is the first brachial cyst to be reported in the pyriform fossa and the second branchial anomalies to be excised transorally with CO2 laser.

Oropharyngeal branchial cyst in a young child

Second branchial cleft cysts are almost always located in the neck. Their presence in the oropharynx is extremely rare. An oropharyngeal branchial cyst in a 4-year-old child diagnosed by magnetic resonance and histopathology was presented. Anatomic location and pathological findings indicated the second branchial pouch origin. The cyst was excised transorally. Six months' follow-up of the child was uneventful and there was no recurrence.

Atypical imaging observations of branchial cleft cysts

The aim of the present study was to assess the atypical imaging manifestations of branchial cleft cysts (BCCs) confirmed by pathology. Computerized tomography (CT) or magnetic resonance imaging (MRI) of 17 BCC cases were reviewed. The imaging features, including laterality, location, border, attenuation and internal architecture, were evaluated. All 17 cases were second BCCs, including 5 cases of Bailey type I classification cysts and 12 cases of type II classification cysts. The atypical imaging features included signal and morphological abnormalities. The abnormal signal intensities were caused by intracapsular bleeding (n=2) or solidification of cystic fluid (n=2). Intracystic hemorrhaging revealed homogeneous hyperintensity on T1-weighted image (T1WI) and T2-weighted image (T2WI). Solidification of cystic fluid revealed slightly homogeneous hyperintensity compared with muscle on T1WI and homogeneous hypointensity on T2WI without enhancement. The aberrant morphology mainly presented as thickening of the cystic wall (n=13). Thickened walls of BCCs with ill- (n=5) or well- (n=8) defined borders were observed in 13 patients. In 3 patients, significant enhancement was identified following intravenous gadolinium administration (n=4). When with atypical CT or MRI features are presented, the typical location of BCCs can help in the diagnosis, as it is located at the lateral portion of the neck adjacent to the anterior border of the mandibular angle or sternocleidomastoid muscle. The atypical observations, including variable signals, imply that the cystic content has changed. Thickened walls indicate inflammation or cancerous tendency and patients with ill-defined margins, vascular involvement or lymphadenopathy atelectasis indicate malignant conversion.

Conservative surgical treatment of pharyngeal branchial cyst

The parapharyngeal presentation of a branchial cleft cyst of the second arch is extremely uncommon. The treatment considered to be most effective is total extirpation via a transcervical approach, but this is not without its complications. A case is described here of a patient who requested conservative treatment. Thus, a transoral exeresis of the oropharyngeal wall of the cyst was carried out, the cyst was drained, and its borders were marsupialized to the pharyngeal wall. Postoperative evolution was towards obliteration of the tract, as should have occurred in the embryonal period.

Imaging of nasopharyngeal cysts and bursae

Cysts and bursae of the nasopharynx are uncommon and seldom symptomatic when compared with malignant tumors of this region. However, it is noteworthy that in the presence of symptoms, a good knowledge of their radiological appearance is useful to establish the correct diagnosis. Cysts of Rathke's pouch, pharyngeal bursa of Luschka, Tornwaldt's cysts, retentional cysts of the seromucinous glands, oncocytic cysts, intra-adenoid cysts, branchial cysts, prevertebral or retropharyngeal abscess and pseudocysts of the nasopharynx will be discussed in this paper.

Epithelial cyst of the soft palate

Epithelial cysts are benign epithelium-lined lesions that contain fluid or semisolid material. This type of cyst is rare in the oral cavity. Most epithelial cysts in this location are situated in the anterior floor of the mouth; the soft palate is seldom affected. Oral examination in a 6-year-old boy revealed a cyst in the soft palate. The lesion was excised under general anesthesia, and histopathological examination identified it as an epithelial cyst. The report discusses this rare location for an epithelial cyst and reviews the pertinent literature.

[Pharyngeal branchial cyst: description of one clinical case]

Brachial cysts are abnormalities in the development of the branchial apparatus, being the more common ones those of the second arch. Cysts localized in the pharyngeal wall (Bailey's type IV) are extremely rare; therefore its differential diagnosis should include all benign and malignant lesions that can be found in the pharyngeal wall. Treatment is the total excision of the cyst through per oral or external cervical approach in order to avoid recurrences.