First branchial cleft cyst: A rare presentation with mesotympanic extension

Coronal CT showing cystic lesion in parapharyngeal space extending toward middle ear.

Coronal CT demonstrating branchial cleft cyst extending from parapharyngeal space toward submandibular region.

Intraoperative view of left middle ear: demonstrates cholesteatoma in mesotympanum.

Intraoperative view after superficial parotidectomy: demonstrates branchial cleft cyst extending from submandibular region, deep to facial nerve, and toward the hypotympanum.

Specimen.

Adapted drawing of Work's classification of first brachial cleft cysts; Work WP. Newer concepts of first branchial cleft defects. Laryngoscope. September 1972;82(9):1581–1593.