Infected branchial cyst excision – the importance of timing and technique

Branchial cysts are the most frequent congenital lesions in the lateral neck. We present a surgical case of a 38-year-old man who visited our clinic with a one-month history of left sided level II neck swelling associated with neck discomfort and left sided otalgia.  Clinical examination revealed a firm yet mobile mass. Both ultrasound scan and CT scan showed a cystic lesion of 5cm x 4cm x 3cm in dimension lying lateral to the carotids without vascular invasion. Planned surgical excision had to be delayed due to cyst infection at the time of surgery for four weeks. Usage of the tonsillar dissector for difficult dissection enabled removal of the cyst without rupture.