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Clinical Problem Solving: Pathology
November 2004

Pathology Quiz Case 2—Diagnosis

Author Affiliations


Arch Otolaryngol Head Neck Surg. 2004;130(11):1339. doi:10.1001/archotol.130.11.1339

First branchial cleft anomalies are relatively rare congenital anomalies of the head and neck. They represent about 8% of all branchial cleft anomalies.1 Most cases occur in the pediatric population.2-4 Although more common in children, first branchial cleft anomalies may present in adulthood if the cysts have not been infected during youth, as in the present case.5 The pharyngeal (branchial) arches form between the third and fourth week of fetal development. Between each arch, on the ectodermal side, a cleft forms in the fifth week of development. The first cleft normally develops into the external auditory canal, while remaining clefts ultimately have no viable structure.3 The pathogenesis of first branchial cleft anomalies is uncertain, but it has been suggested that those with significant lymphatic infiltrates could actually be metaplastic lymph node epithelial rests or, when branchial in origin, have intricate relationships with the structures formed by the first and second arches.6