A remnant of the second branchial pouch and/or cleft may present in a number of ways.

Second Branchial



stapes, styloid process, root of tongue, lesser horn and part of body of hyoid bone, foramen secum, medan anlage of thyroid gland


palatine tonsil, supratonsilar fossa


Type of lesion:

(1) cyst (mobile, painless swelling)

(2) sinus emptying into the pharynx (may swell if drainage is poor or if food and fluid accumulate)

(3) sinus emptying onto the skin surface

(4) fistula


The lesion may involve:

(1) lower third of the neck anterior to the border of the sternocleidomastoid muscle

(2) carotid sheath and/or bifurcation of the carotid arteries

(3) upper half of the posterior tonsillar pillar or tonsil itself


Lining of the lesion:

(1) ciliated epithelium

(2) stratified squamous epithelium

(3) lymphoid tissue in wall


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