Author(s)
Kinneri Mehta, MD
Maheep Sohal, MD
Clinton Kuwada, MD
Gregory Bonaiuto, MD
Affiliation(s)
University of Connecticut Health Center
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to describe the different types of second branchial cleft cysts based on location and the utility of magnetic resonance imaging in diagnosis and surgical planning. They should also be able to discuss the different surgical approaches to this type of lesion. Objectives: To discuss an uncommon presentation of a second branchial cleft cyst including the diagnostic workup and surgical considerations involved in management. Study Design: Case report and literature review. Methods: This is a case report describing a 22 year old patient with a history of tonsillectomy who presented with odynophagia and was found to have a right parapharyngeal space mass that was removed via transoral resection. Results: Though initially thought to be infectious based on the history and exam, the diagnosis was eventually clarified with the use of imaging and pathology results. Computed tomography demonstrated a well circumscribed isoattenuating lesion of the right parapharyngeal space. Magnetic resonance imaging further delineated a cystic lesion with signal hyperintensity on T1 weighted sequence and thin peripheral enhancement on post-contrast imaging suggestive of a branchial cleft cyst. Given the patient's persistent symptoms, surgical management was recommended. The patient has recovered well after transoral resection of the mass. Conclusions: Congenital lesions, specifically branchial cleft cysts, are rare causes of parapharyngeal space masses. While fine needle aspiration may be inconclusive, imaging modalities including computed tomography and magnetic resonance imaging can prove useful in the assessment and surgical planning of these lesions. This case demonstrates the diagnostic management of an uncommon cause of a parapharyngeal space mass and the surgical considerations involved in resection.