 Second branchial cleft anomaly
 Cyst or
Sinus or Fistula
Clinical features
• Sinus present in first decade
• Tiny pit in the skin anterior to the lower 1/3rd of
Sternomastoid
• Palpable cord running upward in the neck from the
ostium
• Milking – mucoid discharge
 Cysts present later
 Soft fluctuant mass deep to upper third of
sternomastoid
 Can get infected
Treatment
 Surgical excision of the cyst or complete sinus tract
 If infected – Antibiotics +/- Needle aspiration followed
by excision after an interval
 To avoid Incision and drainage
 Single or stepladder incisions for sinus/fistula
 Hypoglossal, Glossopharyngeal nerves and internal &
external carotid arteries
 Remnants of the thyroglossal tract
 Midline swelling – below, around and above the hyoid
 Soft midline swelling
 Moves up with swallowing and protuding tongue
 May get infected
Rupture/drainage
Fistula
Differential diagnosis
 Dermoid cyst
 Median ectopic thyroid
 Lymphnodes
 Thyroid
Investigation
 Ultrasound
 Radionuclide thyroid scan
Treatment
 Infected – Antibiotics +/- aspiration
 Non infected cyst or fistula – complete surgical
excision of the track – SISTRUNKS’ OPERATION
 Removing central part of hyoid bone.