A 2nd BCC is the most common BCC accounting for >90% of Retention cyst with epithelial lining resulting

ning resulting from trauma or

1.  To review the normal anatomy of the branchial clefts and all BCC anomalies. It is considered a failure of closure of the inflammation of sublingual gland or minor salivary glands. May
arches (BA) with embryological correlation. cervical sinus. Typically presents as a painless mass along rupture out posteriorly into submandibular space creating a
2.  To illustrate the imaging findings in classic congenital the sternocleidomastoid (SCM), but may become infected. pseudocyst lacking epithelial lining.
cystic masses affecting the head and neck.
3.  To discuss the list of differential diagnosis when
examining congenital cysts of the head and neck.

The main bony structures of the BA consist of a maxillary

process and a mandibular process. The mesenchyme of the
maxillary process gives rise to the maxilla, zygomatic bone
and part of the temporal bone through membranous
ossification. The mandible is also formed by membranous
ossification of mesenchymal tissue surrounding Meckel’s 14a 14b
10a
cartilage. 10b

TMJ
Maxilla
16d
Ramus of
mandible Intermaxillary
suture
Angle of
mandible
Mandibular
symphysis
Body of 10c 10d 14c 14d
mandible

Mental
Mental tubercle
foramen
Hyoid
1

Dermoid cyst are rare congenital lesions derived from

Remnant of thyroglossal duct found between foramen ectodermal differentiation. Thought to occur in this location
Zygomatic
arch cecum of tongue base & thyroid bed in infrahyoid neck. A due to incarcerated pluripotent tissue during fusion of 1st &
TMJ failure of involution of the TGD & persistent secretion of 2nd BA. Only a minority are seen in this location. The most
epithelial cells lining the duct. Can occur anywhere along frequent location in the head & neck is the peri-orbital
Ramus of route of descent of the TGD. Most often embedded in the region.
mandible Orbitomeatal infrahyoid strap muscles. Can be associated with thyroid
plane
carcinomas.

Angle of Condylar
mandible process

Coronoid
Body of process
mandible

15a 15b 15c

Hyoid
2

11a 11b

The BA, also called pharyngeal arches, develops in early
fetal life. The BAs develop in the 4th and 5th weeks of
development. The 1st BA is located between the stomodeum
and the first pharyngeal groove. This arch divides into a
maxillary and a mandibular process. The maxillary process
becomes the maxilla and palate. The 2nd BA or hyoid arch
gives rise to the stapes, styloid process and upper part of
the body of the hyoid.
11c
Lymphangiomas are spectrum of congenital lesions,
differentiated by size of dilated lymphatic channels. Uni- or
multiloculated nonenhancing insinuating cystic neck mass
which may occur in any head & neck space but usually occur
in more than one space. Submandibular space most common
followed by sublingual space. Seen in Turner syndrome.
Thought to be due to embryonic lymph sacs left behind in
embryogenesis.
11d

3 4
Cystic neck mass found along course of embryologic tract
from pyriform sinus to mediastinum which results from failure 16a 16b
of complete involution of thymopharyngeal duct. Typically
seen as a nonenhancing cystic mass in lateral infrahyoid neck
often adjacent to the carotid space.

16c 16d
5

12a 12b

7 8

12c 12d

A 1st BCC is a cystic mass that arise in the parotid, posterior

submandibular space or preauricular region. It is a remnant of
the 1st branchial cleft due to incomplete closure in utero.
Rare congenital (typically acquired) thin walled air or fluid-
filled cystic lesion communicating with laryngeal ventricle in
The first branchial arch is the first of six branchial arches and
the paraglottic or submandibular space. Appendix of the
is the embryological origin of most of the structures of the
laryngeal ventricle (aka saccule) is site of origin of laryngocele.
face. A wide variety of congenital conditions may arise from its
contents. Understanding of the anatomic formation of this
region is important in understanding abnormalities in
development which aids in formation of a precise diagnoses
and lists of differentials.

9a 9b
1. StatDx. Amirsys, Inc.; 2009
2. Alvi A, Weissman J, Myssiorek D, Narula S, Myers EN. Computed tomographic
and magnetic resonance imaging characteristics of laryngocele and its
variants. American journal of otolaryngology 1998;19:251-256
13b 3. Behl A. Giant Epidermoid Cyst of the Floor of Mouth. MJAFI 2001;57:247-249
4. Brauchle RW, Risin SA, Ghorbani RP, Pereira KD. Cervical thoracic duct cysts:
a case report and review of the literature. Archives of otolaryngology--head &
neck surgery 2003;129:581-583
5. Glastonbury CM, Davidson HC, Haller JR, Harnsberger HR. The CT and MR
imaging features of carcinoma arising in thyroglossal duct remnants. Ajnr
2000;21:770-774
6. Larsen WJ. Human embryology. New York: Churchill Livingstone; 1993
7. Lev S, Lev MH. Imaging of cystic lesions. Radiologic clinics of North America
2000;38:1013-1027
9c 9d 13c 13d 13e 8. Macdonald AJ, Salzman KL, Harnsberger HR. Giant ranula of the neck:
differentiation from cystic hygroma. Ajnr 2003;24:757-761
9. Moore KL, Dalley AF. Clinically oriented anatomy. Philadelphia: Lippincott
Williams & Wilkins; 1999
10. Sadler TW, Langman J. Langman's medical embryology. 10th ed.
Philadelphia: Lippincott Williams & Wilkins; 2006;xiii, 371 p.
11. Som PM, Curtin HD. Head and neck imaging. St. Louis, Mo.: Mosby; 2003