Efficacy and safety of ethanol ablation of Branchial Cleft Cysts.

Efficacy and safety of ethanol ablation PEI of Branchial Cleft Cysts.

Image of a 50 ml Branchial cleft cyst in the right neck below the ear.

Case: The above patient has a mass the upper neck. Prior evaluations by ENT physicians including drainage had resulted in continued regrowth.He knew he had this for many years. This year he began to have symptoms and it became visible to him and others. The ENT recommended an extensive surgery to remove the the cyst as it was obviously a parotid cyst by removing the parotid. This required a standard incision around the ear. He found me on my thyroid.com website and came in to see if I could treat this without surgery. Ultrasound  and FNA confirmed a pure cyst. The fluid was brown and 50 ml in size. The FNA did not confirm a rare parotid cyst. The cells were squamous not parotid.

and there were no amylase crystals seen below

or mucin or saliva.

in the fluid.The diagnosis was a congenital branchial cleft cyst.

After explaining ethanol ablation he consented to have the procedure after the viral situation has resolved. There is a big difference from a parotid cyst. There was potential PEI multiple treatments, saliva drainage and a poor final appearance. Parotid surgery includes incision around the ear and has serious complications.

Ethanol treatment for his cyst is the treatment of choice.

Here is a paper with 22 cases treated with ethanol.

Efficacy and safety of ethanol ablation PEI of Branchial Cleft Cysts.

AJNR vol. 38  p.2351-56

HA EJ et al

Dr.Guttler’s comments:

1. 22 patients treated with PEI.
2. 20/22 were followed.
3. All had negative biopsies.
4. Fluid removal was followed by injection of  50-90% 99% ethanol of the removed cyst fluid.
5. Original volumes were 27 ml  mean and range ( 4-50 ml ).
6. Mean Volume reduction was 94% range was 76-100%.
7. 20/20 had success in size reduction, symptoms and cosmetic issues.
8. 1/20 had a intracystic hemorrhage during the treatment.
9. No major complications in any patient.
10. Conclusion of the study. PEI is an effective and saafe treatment for patients with branchial cleft cysts who refuse surgery or had co-morbidity issues excluding surgery.
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