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Surgery Miscellaneous (Neck) 228f224f

All the following are true about branchial cyst except:

A
It occurs at lower 2/3rd of sternocleidomastoid
B
It is lined by squamous epithelium
C
It develops from remnants of 2nd branchial cyst
D
Usually presents in early or middle adulthood
High-Yield Explanation
Ans: A (It occurs at lower 2/3rd of sternocleido-mastoid) Ref: Bailey & Love '5 Short Practice of Surgery, 25th Edition, pg. 728Explanation:Branchial cyst is located at the junction of the upper third and middle third of the sternomastoid muscle at its anterior border.BRANCHIAL CYSTAetiopathologyDevelops from the vestigial remnants of the second branchial cleftLined by squamous epithelium.Contents - thick, turbid fluid full of cholesterol crystals.Clinical FeaturesPresents in the upper neck in early or middle adulthood.At the junction of the upper third and middle third of the sternomastoid muscle at its anterior border.Soft, fluctuant swellingTransillumination may be presentMay be difficult to palpate in early stages because of soft consistency.ComplicationsMay get infected-becomes erythematous and tender may be difficult to differentiate from a tuberculous abscess.InvestigationsUltrasound neckFine-needle aspirationTreatmentComplete surgical excision.Surgery is best done when the lesion is quiescent.Technical DetailsAnterior aspect of the cyst is easy to dissect.Passes backwards and upwards through the bifurcation of the common carotid artery as far as the pharyngeal constrictors.It passes superficial to the hypoglossal and glossopharyngeal nerves, but deep to the posterior belly of the digastric.These structures and the spinal accessory nerve are at risk of injury during surgery.

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