Unusual Presentation of Second Branchial Cleft Cyst: A Case Report

The management of parapharyngeal pathologies is challenging due to the complex neurovascular anatomy, inaccessibility, and presence of critical structures. A 22-year-old female presented with a 6-month history of recurring severe sore throat, palatal arch asymmetry, uvula edema, and mildly elevated inflammation markers. Previously, under the assumption of recurring peritonsillar and parapharyngeal abscesses, the patient had undergone a tonsillectomy a chaud and 2 “abscess” incision and drainage procedures. Computed tomography and magnetic resonance imaging revealed a parapharyngeal cystic mass extending from the skull base to the oropharynx. Transoral surgical extirpation proved safe and feasible. Histopathologic workup was consistent with a lymphoepithelial cyst, confirming the diagnosis of a Bailey type IV second branchial cleft cyst. Superinfected Bailey type IV cysts can mimic parapharyngeal abscesses. Careful evaluation of all differential diagnoses, including very rare ones like branchial cleft cysts, is warranted prior to surgical treatment.

Cite this article as: Haider SP, Hempel J-M. Unusual presentation of second branchial cleft cyst: a case report. B-ENT. 2026;21(4):187-190.