Original communication| Volume 18, ISSUE 3, P267-286, September 1945

Lateral cervical (branchial) cysts and fistulas

A clinical and pathologic study
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      Congenital cysts and fistulas which appear on the lateral aspects of the neck are referred to as branchial, vestigial, and lateral cervical. There is no unanimity of opinion as to the etiology of these lesions. The work and theory of Wenglowski,4 however, have greatly influenced thought on this subject.
      Several members of the same family, and of one or more generations, may be afflicted. Other congenital lesions also are encountered occasionally in cases of lateral cervical cysts and fistulas.
      A study was made of 319 cases in which operation was performed for lateral cervical cysts or fistulas at the Mayo Clinic. Specimens for pathologic study or data on pathologic findings were available in all cases. Detailed microscopic studies of specimens were made in 287 cases. Painless swelling was the most frequent symptom. In sixty-one cases the lesions were preceded by, or associated with, infections of the upper respiratory tract. Symptoms not infrequently appeared following tonsillectomy.
      In our series patients of both sexes were affected equally. The ages of the patients varied from 4 months to 84 years. The greatest number of patients (37 per cent) were in the third decade. The two sides of the neck were involved approximately equally. The lesions were bilateral in 2 per cent of the cases.
      In the great majority of cases the lateral cervical cyst was located in the upper cervical region near the angle of the jaw.
      In the complete and internal fistulas the internal opening usually is in the supratonsillar fossa. It is difficult to demonstrate clinically.
      Lateral cervical cysts and fistulas must be distinguished from other lesions, especially tuberculous lymph nodes.
      These lesions have a distinct pathology and microscopic examination is essential. The diagnosis of branchial carcinoma is probably erroneous. The lesion designated as “branchial carcinoma” is probably secondary to a healed or undiscovered primary lesion in the nasopharynx.
      Conservative treatment is indicated in the presence of acute inflammation. Complete excision of the cyst or fistulas is the treatment of choice in the great majority of cases. In experienced hands the operative mortality is low.
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