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Branchial Sinus
Learn symptoms, causes, how to treat pediatric branchial sinus, and when to contact a pediatric surgeon in Singapore.
What Is Branchial Sinus In Children?
A branchial sinus is a small abnormal opening or tunnel in the neck that a child is born with. This condition happens when structures that form during early pregnancy don't close completely as they should. The result is a narrow passage that starts from a tiny hole in the skin of the neck and extends inward toward deeper tissues.
Sometimes, instead of having an opening to the skin, the passage is completely closed off beneath the skin, forming a fluid-filled lump called a branchial cyst. Both conditions are types of branchial sinus abnormalities and are present from birth, though they may not be noticed until later in childhood.
These abnormalities typically appear on the side of the neck, usually along the front edge of the large neck muscle. While branchial sinus conditions are harmless at first, they can become infected and cause problems, which is why treatment including branchial sinus removal is often recommended.
Common Symptoms of Branchial Sinus
Many children with branchial sinus have no symptoms at all. The condition is often discovered by parents or doctors noticing a small opening or lump on the child's neck. Problems usually only start when infection occurs.
What You Might Notice
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Small opening or pit on the side of the neck, like a tiny dimple
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Clear or cloudy fluid occasionally draining from the opening
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Painless lump on the side of the neck that feels soft
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Lump that comes and goes or gets bigger during a cold
Signs of Infection
When branchial sinus becomes infected, symptoms are more obvious and need infected branchial cyst treatment:
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Pain and swelling in the neck
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Redness and warmth over the affected area
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Pus or thick discharge coming from the opening
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Fever as the body fights infection
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Rapidly growing lump that becomes painful
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Swollen lymph nodes nearby
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Difficulty moving the neck if swelling is severe
When to See a Doctor
Contact us if you notice an opening or lump on your child's neck, fluid or pus draining from the neck, signs of infection like pain, redness, or fever, or if your child has repeated infections in the same area. We may use imaging like branchial cyst ultrasound, CT, or MRI scans to better understand the problem and plan treatment.
What Causes Branchial Sinus?
Branchial sinus forms during the very early weeks of pregnancy, specifically between weeks 4 and 7. During this time, the baby's face and neck are developing from several tissue structures called branchial arches. These arches normally fuse together and transform into the structures seen in a fully developed baby.
Sometimes, parts of these arches don't close completely. When this happens, a small tunnel or passage remains, creating a branchial sinus. If the tunnel has an opening to the skin, we call it a sinus. If the tunnel is completely closed off, it forms a branchial sinus cyst.
Important Points for Parents
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This is a developmental variation, not something you caused
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It happens very early in pregnancy, before most parents know they're pregnant
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Nothing you did or didn't do during pregnancy caused this
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It cannot be prevented
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It sometimes runs in families
The most common type appears in the middle or upper neck area, along the front edge of the neck muscle.
Consequences of Untreated Branchial Sinus
While branchial sinus is not dangerous, leaving it untreated often leads to repeated problems, especially infections.
Repeated Infections
The main problem with branchial sinus is that it keeps getting infected. The passage provides a pathway for bacteria to enter and creates a pocket where infection can develop. Each time your child gets an infection, they experience pain, swelling, fever, and discharge. These infections need infected branchial cyst treatment with antibiotics every time they occur.
Without branchial sinus removal, infections typically come back even after successful antibiotic treatment. Some children have infections several times a year, missing school and activities each time.
Each infection causes inflammation and scarring. When branchial cyst excision or branchial sinus removal is finally done after multiple infections, the surgery is more challenging. The ideal time for surgery is when there's no active infection, but repeated infections keep delaying treatment.
Abscesses
Sometimes infections become severe and form an abscess (a pocket of pus). Abscesses are very painful, cause rapid swelling, and need urgent drainage in addition to antibiotics. Multiple abscesses create more scarring and make future surgery more complicated.
Ongoing Drainage
Many children with branchial sinus have fluid or pus draining from the opening on and off, requiring constant cleaning. It can smell unpleasant and may be embarrassing, especially for older children and teenagers.
How to Treat Branchial Sinus in Children
The only permanent cure for branchial sinus and cyst is surgical branchial sinus removal. At The Little Surgery, Dr. Ong Lin Yin provides complete care including evaluation with ultrasound/CT/MRI imaging, infected branchial cyst treatment, and expert branchial cyst excision or branchial sinus removal.
Diagnosis and Evaluation
Dr. Ong will carefully examine your child's neck to see the opening or lump, check for signs of infection, and feel the area to understand the extent of the problem.
To plan surgery properly, we use branchial cyst ultrasound, CT, or MRI imaging. These tests help us see exactly where the passage goes, how deep it extends, whether it's near important blood vessels or nerves, and plan the safest surgical approach.
Treating Active Infection
If your child comes to us with an infected branchial sinus, we first need to treat the infection with antibiotics. If an abscess has formed, we drain it to relieve pain immediately. Definitive branchial sinus removal will still be needed later. After treating an infection, we typically wait 6-8 weeks before doing surgery.
Surgery (Branchial Sinus Removal or Branchial Cyst Excision)
Branchial sinus removal or branchial cyst excision is done under general anesthesia for your child’s comfort. Based on the branchial cyst ultrasound/CT/MRI images, Dr. Ong plans the best incision location, usually in a natural skin crease to minimize visible scarring.
For branchial cyst excision, a careful incision is made to find the cyst and remove it completely with all its lining. This usually takes 1-2 hours.
For branchial sinus removal, the surgery is similar but requires following the entire passage from the skin opening to wherever it ends deep in the neck. Every part of the passage must be removed to prevent it from coming back.
Throughout surgery, Dr. Ong carefully protects important structures in the neck including blood vessels and nerves.
Most children go home the same day or the next morning. There will be a small bandage on the neck. Pain is usually mild and controlled with regular pain medicine. A small drain tube may be placed temporarily and is removed within 1-2 days.
Recovery at Home
In the first few days, your child may have some soreness and should rest. Keep the incision clean and dry. Most children feel well enough to return to light activities within a few days.
Your child should avoid strenuous activities and contact sports for 3-4 weeks, but they can usually return to school within a week. Stitches either dissolve on their own or are removed after 5-7 days. With careful surgical technique and proper incision placement, most children heal with minimal scarring that fades over time.
We'll see your child for follow-up visits to check healing, remove stitches if needed, review the lab results from examining the removed tissue, and make sure everything is healing well. Once completely removed, branchial sinus rarely comes back.
Why Choose The Little Surgery for Branchial Sinus Treatment
We provide complete care for branchial sinus including evaluation with ultrasound/CT/MRI imaging, infected branchial cyst treatment when needed, and expert branchial cyst excision or branchial sinus removal.
Experienced Pediatric Surgeon
Dr. Ong Lin Yin has over 20 years of experience treating children with branchial sinus. As the former Head of Paediatric Surgery at KK Women's and Children's Hospital, she has successfully performed many branchial sinus removal and branchial cyst excision procedures with excellent results and very low rates of the condition coming back.
Comprehensive Care
We handle everything from diagnosis to complete healing including thorough examination and proper imaging, treatment of infections with appropriate infected branchial cyst treatment, surgery when the timing is right, and supportive follow-up care.
Dr. Ong uses precise techniques to remove the entire branchial sinus or cyst, protect all important neck structures, place incisions for the best cosmetic result, and ensure the problem won't come back.
Understanding Your Concerns
As a mother herself, Dr. Ong understands how parents feel when their child needs surgery. She takes time to explain everything clearly, answer all parents’ questions, discuss what to expect, and support your family through the process.
Contact The Little Surgery Today
If your child has an opening or lump on the neck, we can help.
Contact The Little Surgery today and take the first step toward ensuring your child's health and happiness.