Most common, presents as a lump or dimple, may be connected to tonsillar fossa or pharynx
4 Types of 2nd Branchial Cleft Cyst
| Feature | 2nd branchial cleft cyst | Carotid Body Cyst Body Cyst/Tumor |
|---|---|---|
| Origin | Congenital remnant of branchial apparatus (typically cleft/pouch fusion) | Paraganglioma of neural crest origin (carotid body hyperplasia) |
| Common Age Group | Often presents in late childhood or early adulthood | Usually in adults (30–60 years), slow-growing |
| Laterality | Usually unilateral | Often unilateral, but can be bilateral in familial cases |
| Consistency | Soft, fluctuant, cystic | Firm, non-cystic, pulsatile if vascular |
| Mobility | Mobile | Moves side-to-side but not up-down (Fontaine’s sign) |
| Imaging Features | Well-circumscribed cystic mass on ultrasound/CT | Hypervascular solid mass on Doppler or contrast imaging |
| Symptoms | Painless swelling, may become infected | Mass effect (e.g., dysphagia, hoarseness), pulsatile mass |
| Histology | Stratified squamous epithelium, lymphoid tissue | Paraganglioma: nests of chief cells (“zellballen” pattern) |
| Management | Surgical excision | Surgical resection ± pre-op embolization; observe if asymptomatic |
2nd Branchial Cleft Cyst
Carotid Tumor