Excision of Branchial Cleft Cyst/Sinus
This chapter describes the surgical procedure for excision of branchial cleft cyst/sinus as performed by the following approach: open. Indications for the procedure include a visible pit on the anterior border of the sternocleidomastoid. Occasionally, fluid may drain from the pit or the sinus can become infected and require incision and drainage and delayed repair. Risks of the surgery include damage to the glossopharyngeal, vagus, and hypoglossal nerve, the carotid sheath, and incomplete ductal excision. There is no alternative to surgical excision, although in the case of early diagnosis with no history of infection, surgical excision can be delayed for several months to diminish the risks of general anesthesia in an infant. Essential steps include cannulation of the sinus, elliptical incision around sinus opening, dissection up the length of the sinus tract, transverse step ladder incision(s) along the length of the sinus tract, and suture ligation of the base of the sinus.