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Video

Head and Neck Surgery

(A511) Atypical Branchial Cleft Cyst with Parapharyngeal Involvement: A Case Report

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • NW

    Nicole L. Wershoven, MD

    Resident
    University of Colorado Department of Otolaryngology
    Aurora, Colorado, United States

    • Co-Author(s)

  • Drew Cameron Gottman, MD

    Resident
    University of Iowa Clinics and Hospitals
    Iowa City, Iowa, United States

    • Senior Author(s)

  • Brian Cervenka, MD

    Assistant Professor, Otolaryngology - Head and Neck Surgery
    University of Colorado Department of Otolaryngology
    Aurora, Colorado, United States

Disclosure(s):
Drew Cameron Gottman, MD: No relevant relationships to disclose.
Nicole L. Wershoven, MD: No relevant relationships to disclose.
Brian Cervenka, MD: No relevant relationships to disclose.


Introduction: Branchial cleft cysts, congenital anomalies arising from incomplete obliteration of the branchial apparatus during embryogenesis, present diagnostic and therapeutic challenges, particularly in atypical adult cases. This case report aims to explore the diagnostic complexities and surgical management strategies for an unusual branchial cleft cyst with mixed characteristics and parapharyngeal space involvement.

Methods: This case report details the management of a 27-year-old female with an atypical branchial cleft cyst extending into the parapharyngeal space. The patient was evaluated and treated in a tertiary care hospital using imaging studies, including CT and MRI, followed by staged surgical interventions. Initial conservative management with antibiotics and drainage was unsuccessful, leading to a posterior superficial parotidectomy and transoral excision of the cyst tract. Outcomes were assessed through symptom resolution and imaging findings.

Results: The patient underwent a series of evaluations and interventions. Initial conservative management with antibiotics and drainage provided temporary symptom relief but did not prevent recurrence. Definitive surgical management included a posterior superficial parotidectomy, followed by transoral excision of the residual cyst tract. These interventions successfully addressed the cyst and its associated tract, with the patient remaining symptom-free without recurrence at follow-up.

Conclusions: This case demonstrates a unique presentation posed by atypical branchial cleft cysts in adults, particularly those with complex extensions into deep neck spaces. While initial conservative management may provide temporary relief, definitive surgical excision is often necessary to prevent recurrence and improve patient outcomes. This report highlights the importance of individualized surgical planning, as well as the utility of a transoral approach in accessing the parapharyngeal space with reduced morbidity.