Figure 8.  Second branchial cleft tract. Drawing shows the path of second branchial cleft anomalies, which can occur anywhere along a line from the supraclavicular region to the oropharyngeal mucosa. The path travels lateral to the common carotid artery, then heads medially between the external carotid (EC) and internal carotid (IC) arteries under the glossopharyngeal nerve (IX) and above the hypoglossal nerve (XII). If the tract continues further along this course, it will enter the parapharyngeal space and pierce the middle constrictor muscle before ending as an opening within the tonsillar fossa. (Reprinted, with permission, from reference 5.)