Proximity to which of the following structures places it at risk during surgical excision of a second branchial cleft remnant?

d. All of the above

Operative excision of a second branchial cleft remnant begins with an elliptical transverse incision at the sinus opening and cephalad dissection of the tract to its furthest extent, generally reaching the floor of the tonsillar pillar. The dissection is kept directly on the tract to avoid injury to contiguous structures such as the internal jugular vein, the internal or external carotid arteries (between which it passes), and the hypoglossal nerve. The operation can almost always be carried out through a single cosmetic incision if the tract is kept under traction and digital pressure is exerted through the tonsillar fossa. Dissection of the sinus tract may be facilitated by passing a fine silver probe or piece of heavy nylon suture through the length of the tract.