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First Branchial Cleft Cyst - Radiology

last modified on: Mon, 12/04/2023 - 16:22

see also: Branchial Cleft Fistula First Arch Case Example

  • A congenital cyst that presents in close relation to the parotid region, facial nerve, and external auditory canal - a remnant of the 1st branchial cleft (Mehmi et al. 2019)
  • Typically located in the periauricular area (Fastenberg et al. 2016)
  • Work type 1 cysts contain only ectoderm and are located preauricularly, tracking anteriorly/medially to the external auditory canal (Coste et al. 2023)
  • Work type 2 cysts contain both ectoderm and mesoderm and are located at the angle of the mandible or submandibular region (Coste et al. 2023)
  • Rare, with type II cysts more common than type I (Coste et al. 2023)
  • On exam, typically smooth, non-tender, and fluctant mass
    • Otologic exam is important as there may be a connection to the middle or external ear (Coste et al. 2023)
  • Most presentations occur in the first two decades of life (Mehmi et al. 2019), consider in the setting of recurrent parotid infections
  • On CT: Low density or isodense (if infected) without contrast; with contrast non-enhanching or mildly rim enhancing - stranding and enhancement if infected
  • On MR: low signal on T1; high signal with potential sinus tract on T2; T1 post-contrast will be low signal unless recent or current infection


Mehmi N, Kumar R, Sagar P, Singh CA, Kumar R, Thakar A, Sharma SC. Importance and Impact of Appropriate Radiology in the Management of Branchial Cleft Anomalies. Indian J Otolaryngol Head Neck Surg. 2019 Oct;71(Suppl 1):953-959. doi: 10.1007/s12070-019-01634-w. Epub 2019 Mar 23. PMID: 31742101; PMCID: PMC6848690.

Coste AH, Lofgren DH, Shermetaro C. Branchial Cleft Cyst. 2023 Jun 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29763089.

Fastenberg J, Nassar M. First Branchial Cleft Cyst. N Engl J Med. 2016 Oct 20;375(16):e33. doi: 10.1056/NEJMicm1503044. PMID: 27797306.