¶ … practitioner in a family medical practice, a physician will see an assortment of ailments. Many inflicted individuals first seek aid in a family practice setting. From that point multiple outcomes and referrals are possible. The treatment can also vary greatly. Treatment can range from a simple dose of antibiotics to surgery. In this aspect, family clinics and physicians are of great importance in American society. Branchial cleft cysts are fairly uncommon and there are three known types. As it is the result of a recessive genetic disorder, both parents must be carries for the ailment. "The birth defect may appear as open spaces called cleft sinuses, which may develop on one or both sides of the neck. A branchial cleft cyst may form from fluid drained from a sinus. The cyst or sinus can become infected" (McGuirt, 2005). This type of cyst is generally composed of squamous or columnar cell types and it is not uncommon for a branchial cleft cyst to contain cholesterol crystals. A branchial cleft cyst is also knows as a "pharyngeal fistula." Although sometimes painful, and unsightly this type of cyst is not considered life threatening. Typically these cases are seen by a primary care physician in a family medical practice and then further referred to an otolaryngologist for further assessment and treatment. Case Report

A teenage female is brought into a family clinic on the afternoon of October 21, 2009. For purposes of this assay, she will be referred to as "Patient 1." Patient 1 is a 17-year-old female with a golf-ball sized protrusion from the right side...

Upon further review, she experiences sharp pain when attempting mastication. The lump is tender when pressure is applied. "Branchial cleft cysts are remnants of embryonic development and result from a failure of obliteration of the branchial cleft, which in fish develops into gills" (Hong, 2008).
Patient 1's medical records indicate a congenital second branchial cleft cyst near the anterior border of the sternocleidomastoid muscle. Patient 1 underwent surgery at 18 months old to remove this cyst. Due to the branched nature of cysts, they are likely to recur. Patient 1 is referred for a CT scan to further view the lump in her neck. Review of the CT scan shows exactly what physicians expected. Patient 1 is diagnosed with a branchial cleft cyst once again and referred to an otolaryngologist. Due to the large size and sensitivity to touch, the cyst is assumed infected. Surgery is scheduled at Memorial Hermann in Houston, Texas. The otolaryngology department at this hospital specializes in branchial cleft cysts. Patient 1's surgeon states he has only seen four cases of this type of branchial cleft cyst in is 30-year career. The process is explained to Patient 1 in a consultation appointment two weeks after diagnosis.

Discussion

"Phylogenetically, the branchial apparatus is related to gill slits. In fish and amphibians, these structures are responsible for the development of the gills, hence the name branchial (branchia is Greek for gills)" (Hong C.-H., 2010). As these cysts are typically asymptomatic, (unless it is prior to the first…