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Second Branchial Cleft Anomalies Presenting as Pharyngeal Masses

Second branchial cleft anomalies are the most common of all branchial cleft defects. Characteristically, they present as either a fluctuant mass or an external opening along the anterior border of the sternocleidomastoid muscle. When they occur in this stereotypical fashion, diagnosis is straightforward. Seventy-six percent are diagnosed accurately on initial presentation.’ When their presentation deviates from the expected, however, accurate diagnosis is a challenge. Misdiagnosis is more likely to occur, and inappropriate management with subsequent recurrence may follow. Two cases of second branchial cleft anomalies manifesting as pharyngeal masses are described. One was a cyst involving the tonsil alone, whereas the second was a tonsillar cyst associated with a sinus tract extending into the neck. To explain them, it is necessary to reexamine and modify current theories concerning the embryogenesis of branchial cleft anomalies.