Parapharyngeal Second Branchial Cleft Cyst Extending to the Skull Base: A Lateral Transcranial Infratemporal fossa Approach

Abstract

Branchial cleft cysts, sinuses, and fistulae are classified as first, second, third and fourth branchial cleft anomalies. They represent the congenital anomalies resulting from defects in the normal maturation of the branchial apparatus. Second branchial cleft anomalies occur more commonly than other branchial cleft anomalies. Most branchial cysts from the second branchial cleft are found deep in the sternocleidomastoid muscle or along its anterior border. Recognizing and diagnosing lateral neck cysts correctly are not difficult for an expert physician, although an unusual localization may cause problems in differential diagnosis. Complete excision of branchial cleft cysts is necessary to avoid recurrence. Approaches to the lesions are depending on the location and extent of the lesion. This article presents an unusual case of parapharyngeal branchial cleft cyst extending the skull base. Excision of the lesion was achieved via the lateral transcranial infratemporal fossa approach with zygomato-temporal craniotomy. This approach provides access not only to all of the subcranial tissues that underlie the middle cranial fossa, but to the maxillary or sphenoid sinus.