What are the steps for branchial cleft cyst removal

Branchial cleft cyst is a common disease in clinical practice. It is also a congenital disease, which is closely related to the development of the embryo. Branchial cleft cyst is prone to occur in people of all ages. Therefore, when treating, we must consider the characteristics of their age and pay attention to prescribing the right medicine. The growth rate of branchial cleft cyst is relatively slow, but when it grows up it will also have a certain impact on people's body and life. Therefore, the problem of branchial cleft cyst must be treated in time. Surgery is the fundamental method to treat branchial cleft cyst. The removal of branchial cleft cyst also has many steps, which need to be done step by step, so that the surgical effect will be better.

1. Incision

A longitudinal incision is made along the front edge of the sternocleidomastoid muscle. The length of the incision should be equal to or slightly longer than the size of the cyst. Alternatively, a transverse arc-shaped incision can be made below the mandibular angle and on the surface of the cyst.

2. Expose the cyst

According to the incision design, the skin, subcutaneous tissue and platysma muscle are cut open, the external jugular vein is ligated and cut off, the sternocleidomastoid muscle located superficial to the cyst is separated and pulled back to expose the cyst.

3. Removal of cyst

Start from the bottom of the cyst, gradually separate the internal jugular vein and carotid artery deep in the cyst, and then gradually separate upwards along the cyst wall. Because the cyst wall is often adhered to the internal jugular vein, blunt separation should be performed with caution to avoid damaging the internal jugular vein, common carotid artery, internal and external carotid arteries, and vagus nerve. When separating the cyst from the deep surface behind the upper part of the sternocleidomastoid muscle, it is also necessary to avoid damaging the accessory nerve. The anterior wall of the cyst is sometimes adhered to the common facial vein, so caution should be exercised when separating the anterior wall. If necessary, the common facial vein can also be ligated and cut off. When separating to the deep surface of the digastric muscle, the cyst needs to be separated from the muscle belly, and care must be taken to avoid damaging the hypoglossal nerve. Continue to separate in this way and the cyst can be completely removed. However, if the cyst protrudes toward the lateral wall of the pharynx through the internal and external carotid arteries, it needs to be completely removed when the lateral wall of the pharynx is separated. If a duct is found connecting the cyst to the pharynx, the duct needs to be removed and a purse-string suture should be made on the pharyngeal mucosa.

4. Suture

The wound cavity was flushed, and after complete hemostasis, it was sutured in layers and a drainage strip was placed.