The relationship of pouches to clefts can result in remnants that are sinuses internally to the pharynx, externally to the skin, or cysts with or without connection to either surface. Cleft I remnants are rare (< 1% of branchial cleft remnants) and either involve the parotid gland (and CN VII) or emerge below the ear. These may present as a painless swelling of the parotid and may be associated with the external ear canal. These are different from pre-auricular inclusion cysts. Cleft II remnants are more common and are located anterior to the sternocleidomastoid. The tract may run between the internal and external carotid and may have an internal opening at the superior pole of the tonsil. The tract must be completely excised. Remnants of the third cleft lie deep to the carotids and may have an internal opening into the pyriform sinus (see larynx anatomy).
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