Fourth branchial cleft cyst with no identifiable tract: Case report and treatment approach

July 5, 2012     Peter Dziegielewski, MD; Jason Chau, MD, FRCSC; Sarfaraz Banglawala, MD; Hadi Seikaly, MD, FRCSC


We describe a rare case of a fourth branchial cleft cyst that had no identifiable tract. The patient was a 23-year-old man who presented with recurring neck abscesses. After six similar episodes, computed tomography finally demonstrated that the most recent abscess had extended into the thyroid gland, a finding that led to the correct diagnosis. Extensive surgical extirpation of the cyst with an adjacent neck dissection was performed, and the patient remained symptom-free at 25 months of follow-up. The occurrence of a fourth branchial cleft cyst with no clear tract presents a surgical dilemma, as complete dissection cannot be guaranteed. Consequently, such patients are predisposed to recurrence. We propose that definitive management of a fourth branchial cleft cyst with no identifiable tract focus on eliminating the likely embryologically based path of bacterial seeding. This includes a hemithyroidectomy in conjunction with a selective neck dissection to cover all areas where a fourth branchial tract may lie within the neck.

Aneurysmal bone cyst at the base of the skull

April 30, 2012     Arun Goyal, MS; Shalabh Rastogi, MS; P.P. Singh, MS; Sonal Sharma, MD


Aneurysmal bone cysts have been described as pseudocysts in view of their lack of an epithelial lining. These cysts are uncommon, but when they do occur they typically involve the long bones of the extremities, the membranous bones of the thorax and pelvis, and the vertebrae. Skull involvement is uncommon. We present the case of a 14-year-old girl who presented with nasal obstruction and a swelling of the right cheek. Contrast-enhanced computed tomography detected a heterogeneous cystic mass involving the sphenoid and ethmoid bones. The mass was excised via a lateral rhinotomy approach, and it was identified as an aneurysmal bone cyst on histologic examination. The patient experienced a recurrence in the right sphenoid sinus within 3 months, and the lesion was removed via transnasal endoscopy.

Endoscopic view of maxillary ostia mimicking a maxillary sinus wall

March 1, 2012     Joseph P. Mirante, MD, FACS, Dewey A. Christmas, MD, and Eiji Yanagisawa, MD, FACS

A patient presented with what appeared to be a defect in the left medial wall of the maxillary sinus but that was actually two large maxillary ostia with the absence of a left uncinate process. He was successfully treated with functional endoscopic sinus surgery.

Ventricular cyst of the larynx

March 1, 2012     Johnathan B. Sataloff, Rima A. DeFatta, MD, Mary J. Hawkshaw, BSN, RN, CORLN, and Robert T. Sataloff, MD, DMA FACS

Surgery for supraglottic cysts may not be necessary in patients in whom the cysts do not grow or interfere with phonation, if these patients will comply with follow-up for close observation. If the mass enlarges or causes severe enough symptoms to warrant the risks of surgery, excision is usually safe and effective.

Cervical thymic cyst presenting as a possible cystic nodal metastasis of papillary carcinoma in a 53-year-old man

September 20, 2011     Woong Na, MD, Si-Hyong Jang, MD, Kyueng-Whan Min, MD, Seok Hyun Cho, MD, PhD, and Seung Sam Paik, MD, PhD


Cervical thymic cysts are rare embryonic remnants that develop along the course of thymic migration in the neck. They usually occur during infancy and childhood, and they are extremely rare in adults. We report a case of cervical thymic cyst in a 53-year-old man. The patient presented with a small mass of the thyroid gland and a cystic mass at the left level II area of the neck. On histopathology, the thyroid mass was identified as a papillary carcinoma and the left-sided neck mass was diagnosed as a cervical thymic cyst lined with nonkeratinizing, flattened squamous epithelium. The cyst wall contained atrophic thymic tissue composed of lymphoid cells, epithelial cords, and Hassall corpuscles. Although it is rare, cervical thymic cyst should be considered in the differential diagnosis of a lateral cystic neck mass in an adult.

A simple method of earlobe lesion excision and repair

June 13, 2011     Samuel J.C. Fishpool, BSc, MRCS(Med), Mohamed M. Abo-Khatwa, FRCS(ORL), and Jonathan E. Osborne, FRCS(ORL)

Ectopic canine associated with a dentigerous cyst in the maxilla

June 13, 2011     Jagdeep S. Thakur, MS, Narinder K. Mohindroo, MS, DLO, Dev R. Sharma, MS, Ravinder S. Minhas, MS, DLO, and Anamika Thakur, MD


Ectopic eruption of a tooth is common in the dental arch, palate, and nose, but it is rare in the maxillary antrum. We present the case of a 35-year-old man with an ectopic canine and an associated dentigerous cyst in the maxillary sinus that masqueraded as an antrochoanal polyp.

An uncommon case of laryngeal oncocytoma

April 30, 2011     Brett Travis, MD, Enrique Palacios, MD, FACR, and Curt L. McCarty, MD

Bilateral saccular cysts

April 30, 2011     Anthony M. Bianchi, MD, Farhad R. Chowdhury, DO, and Robert T. Sataloff, MD, DMA, FACS

Steatocystoma simplex of the infratemporal fossa: An uncommon location for a rare entity

January 1, 2011     Yekaterina A. Koshkareva, MD, Gregory S. Weinstein, MD, Michael Feldman, MD, and Gul Moonis, MD


Steatocystoma simplex is a rare entity characterized by the presence of a solitary cutaneous cyst derived from a sebaceous duct or gland. Multiple locations of this lesion have been reported previously. The purpose of this article is to report the unusual presentation of steatocystoma simplex as an infratemporal fossa mass. To the best of our knowledge, no case of steatocystoma simplex at this site has been previously reported. We also describe the radiologic and pathologic features of this entity, which might aid in diagnosis and management, and we discuss its etiology and treatment options.

Lymphoepithelial cyst of the palatine tonsil

December 17, 2010     Jinsu Choi, MD, Kisik Kim, MD, and Bosung Kim, MD

Role of irrigation with hypertonic saline for a recurrent skull base hydatid cyst: Case report and review of the literature

August 31, 2010     Sadaf Zia, FCPS, Ather Enam, MD, Iftikhar Salahuddin, MD, and Aslam Khan, MD


Hydatid cyst is a parasitic disease caused by the tapeworm Echinococcus granulosus. This disease is a rare finding in the head and neck region, and its presentation varies according to the area involved. We report the case of a 25-year-old woman who presented with bilateral neck swelling, which was found on histopathologic examination to be caused by a hydatid cyst. The patient underwent surgical drainage of the cyst and a modified radical mastoidectomy, followed by a 3-month course of treatment with albendazole. However, she experienced a recurrence in the left neck region 1 year later. At that time, reexploration of the left mastoid cavity was performed, with debridement of diseased occipital bone and foramen magnum. Intraoperatively, we used a novel method of saline irrigation with 3% hypertonic saline, previously not tested on exposed nerves, in an attempt to prevent further recurrence. Four years after the second surgery, no disease recurrence was found, and no neurologic sequelae were noted. We conclude that hypertonic saline irrigation can be considered as an option for preventing recurrence in cases that are difficult to clear surgically, especially around cranial nerves, although more studies are needed to document the safety of this approach.

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