title: Fourth branchial cleft cyst with no identifiable tract: case report and treatment approach.
abstract: We describe a rare case of a fourth branchial cleft cyst that had no identifiable tract. The patient was a 23-year-old man who presented with recurring neck abscesses. After six similar episodes, computed tomography finally demonstrated that the most recent abscess had extended into the thyroid gland, a finding that led to the correct diagnosis. Extensive surgical extirpation of the cyst with an adjacent neck dissection was performed, and the patient remained symptom-free at 25 months of follow-up. The occurrence of a fourth branchial cleft cyst with no clear tract presents a surgical dilemma, as complete dissection cannot be guaranteed. Consequently, such patients are predisposed to recurrence. We propose that definitive management of a fourth branchial cleft cyst with no identifiable tract focus on eliminating the likely embryologically based path of bacterial seeding. This includes a hemithyroidectomy in conjunction with a selective neck dissection to cover all areas where a fourth branchial tract may lie within the neck.
authors: Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 1E4 Walter C. Mackenzie Health Sciences Centre, 8440 112 St., NW, Edmonton, AB T6G 2B7 Canada. ptd@ualberta.ca
authors: Peter
authors: P
authors: Dziegielewski
authors: Jason
authors: J
authors: Chau
authors: Sarfaraz
authors: S
authors: Banglawala
authors: Hadi
authors: H
authors: Seikaly
mesh_terms: D000038:Abscess / Q000473:pathology* / Q000601:surgery; D001934:Branchial Region / Q000473:pathology* / Q000601:surgery; D003560:Cysts / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007964:Leukocytosis; D008297:Male; D009333:Neck / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods*; D055815:Young Adult