Branchial cyst is a type of congenital defect that affects the skin in the lateral part of the neck. This type of cyst can be painful and uncomfortable, this type of cyst is caused by abnormal development of the branchial arches, which are structures in the neck that eventually develop into the jaw, ears, and thymus gland.

They represent 90–95% of branchial anomalies, In the normal course a persistent fistula of the second branchial cleft and pouch passes from the external opening in the mid or lower third of neck in the line of the anterior border of the sternocleidomastoid muscle, deep to platysma along the carotid sheath. The tract then passes medially deep between the internal and external carotid arteries, as in our case, after crossing over the glossopharyngeal and hypoglossal nerves. Finally, it opens internally in the tonsillar fossa.


  • Mucoid discharge from the anterior aspect of neck.
  • mass on one side of the neck that is usually painless
  • Small opening in the skin on the side of the neck that drains mucus or fluid
  • Redness, warmth, swelling, pain, and drainage if infected.


Type I—It lies deep to the platysma muscle and the overlying cervical fascia, anterior to sternocleidomastoid muscle.

Type II— It is thought to be due to persistence of sinus of His. These lie in contact with the great vessels. It is located posterior to submandibular gland, anterior and medial to sternocleidomastoid muscle.

Type III– The tract courses between internal and external carotid arteries and may extend to lateral wall of pharynx or skull base. These are thought to arise from the dilated pharyngeal pouch.

Type IV– It arises from remnant of pharyngeal pouch and lie next to the pharyngeal wall, medial to the great vessels at the level of the tonsillar fossa.


 Clinical and radiological investigations 

  • Fistulogram
  • MRI
  • Usg
  • Ct scan


  • Silicea –Its use is highly recommended for dissolving different types of cyst. It is effective for treating sebaceous cyst, cystic acne, Chalazion, ganglion, pilonidal cyst, knee cyst, breast cyst and cyst in male and female genitals Hence its use is also valuable in treating cases of infected cyst. In such cases it helps in clearing the pus discharges that can be foul smelling.
  • Hepar Sulph –It is a great medicine for managing cases of skin cyst with pus discharge. In cases like cystic acne, pilonidal cyst it works very effectively. There is pus discharge that can be offensive in nature. In the cyst there may be pain, tenderness and sensitivity to touch the lump where it is required. Pain is throbbing and splinter like. 
  • Apis Mellifica - The pain is mainly burning, stinging type. It may also be a sharp cutting type. Other attending symptoms are tightness, weight, heaviness and tenderness in the the neck.
  • Ruta – It is a very beneficial medicine for dissolving cyst. It mainly works best in the ganglion of the wrist.
  • Calcarea Fluor –This medicine has great affinity to treat cystic lumps,It gradually decreases the size of this cyst.
  • Graphites –  It is another prominent medicine for treating cases of sebaceous cysts, like medicine Silicea. In cases needing it, scanty pus discharge from the cyst may be present.
  • Calcarea Sulph – This medicine works well in cases where yellow lumpy discharge are present. the pus is thick. The discharge can also be blood stained. 
  • Bromium – Well-indicated for cyst on neck
  • Baryta Carb – Prominent medicine for cysts under the arm-pit
  • Iodum – An important remedy for thyroid cyst
  • Calcarea picricata – for cystic growth on the the neck.