Branchial cleft remnants most often present with which of the following clinical problems?

a. Infection

The more common second branchial cleft anomalies present typically as a pinpoint opening on the anterior border of the sternocleidomastoid muscle. Attention is drawn to the defect often by the appearance of small drops of clear fluid at the orifice or by occurrence of infection in the tract itself. Less frequently, a mass may present anterior to the upper portion of the sternocleidomastoid muscle representing a cyst derived from this tract. Infection is a more common problem in the older age group. Airway obstruction and hemorrhage are rare presentations. Pain is usually secondary to infection and malignant degeneration is reported but exceedingly rare. Treatment consists of surgical excision. If infection is present, a course of antibiotics is administered first.