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Large First Branchial Cyst Extending into the Parapharyngeal Space: A Case Report.

Takeshi Matsunobu1,2, Takaomi Kurioka3, Kimihiro Okubo1

  • 1Department of Otolaryngology-Head and Neck Surgery, Nippon Medical School.

Journal of Nippon Medical School = Nippon Ika Daigaku Zasshi
|March 25, 2025
PubMed
Summary

A rare first branchial cyst in the parotid region, extending into the parapharyngeal space, was successfully treated. This case highlights the importance of careful surgical management for such complex salivary gland cysts.

Keywords:
Stensen's ductbranchial cystcystic lesioninfectionparotid gland

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Area of Science:

  • Otolaryngology
  • Head and Neck Surgery
  • Surgical Pathology

Background:

  • Cystic diseases of salivary glands are uncommon, with parotid region cysts being particularly rare.
  • Mucous cysts and plunging ranulas are common salivary gland cystic lesions.
  • First branchial cleft anomalies typically present in the upper neck, not the parotid region.

Purpose of the Study:

  • To report a rare case of a first branchial cyst presenting in the parotid region.
  • To describe the clinical presentation, diagnostic approach, and management of this rare entity.
  • To emphasize the surgical considerations for first branchial cysts extending into the parapharyngeal space.

Main Methods:

  • A case study of a 35-year-old female with a parotid mass was presented.
  • Diagnostic imaging (CT/MRI) and fine-needle aspiration biopsy (FNAB) were utilized.
  • Surgical excision of the cyst was performed after initial management of infection.

Main Results:

  • A large first branchial cyst was identified in the parotid region, extending into the parapharyngeal space and communicating with Stensen's duct.
  • The cyst was initially treated for recurrent infections with intravenous antibiotics.
  • Post-operative recovery was uneventful with no recurrence of infection.

Conclusions:

  • First branchial cysts in the parotid region are exceptionally rare and can mimic other parotid pathologies.
  • Extension into the parapharyngeal space and communication with Stensen's duct present unique challenges.
  • Meticulous surgical technique is crucial due to the complex anatomical relationship with the parotid gland and facial nerve.