Branchial cleft cysts usually present as a soft cystic mass along the anterior border of the sternocleidomastoid muscle
These lesions are usually recognized in the second or third decades of life, often when they suddenly swell or become infected
To prevent recurrent infection and possible carcinoma, they should be completely excised, along with their fistulous tracts
First branchial cleft cysts present high in the neck, sometimes just below the ear
A fistulous connection with the floor of the external auditory canal may be present
Second branchial cleft cysts, which are far more common, may communicate with the tonsillar fossa
Third branchial cleft cysts, which may communicate with the piriform sinus, are rare and present low in the neck