Clinical presentation of BCA
Clinically, the majority of BCA present as a painless compressible swelling, draining sinuses, or fistulae situated at the anterior border of SCM in line between the mandibular angle and clavicle. [6] Presenting patients may report a variety of duration and periods of waxing and waning of the neck swelling. Acute size increase can occur due to upper respiratory tract infections. [4] Secondary infections and inflammation can occur, therefore neck abscesses are possible. [7]
Although rare, bilateral second branchial cleft cysts have been reported [8] and in some patients this is part of the branchio-oto-renal syndrome (BOR), an autosomal dominant disorder. [9] BOR or Melnick-Fraser-Syndrome [10] symptoms include hearing impairment, cup-shaped pinnae, preauricular pits, branchial fistulae and renal anomalies. [4] Even though there is a positive predictive value in preoperative diagnosis of BCA, cystic neck masses should presumed malignant. [11]