Presentation of Branchial Cleft Anomalies: Case Reports and Review of Literature (original) (raw)

Second Branchial Cleft Anomalies: Analysis of Our Clinical Experience in 10 Years

KBB-Forum: Elektronik Kulak Burun Boğaz ve Baş Boyun Cerrahisi Dergisi, 2020

Purpose: To review clinical features, the tools used in the diagnosis and the results of surgical treatment of second branchial arch anomalies. Material and Methods: The patients diagnosed with branchial cyst or fistula and managed surgically between January 2008 and December 2018 in the otolaryngology department of a tertiary academic center were reviewed retrospectively. Results: The files of 43 cases with second branchial cleft anomaly were examined. Of these, 39 (90.7%) were cysts and 4 (9.3%) were fistulas. The mean age was 24±13(3-66) years. The main complaint was swelling mass at the neck in all cases(100%). 4 (9.3%) had a history of infected cysts. The mean size of the cysts was 3.29±1.94(2-9.5) cm. Fine needle aspiration cytology(FNAC) was performed in 17 (39.53%) of the cases. Atypical cells-suspicion of malignancy was reported at FNAC of 4 (23.5%) cases, and of 13 cases (76.5%) were reported as benign. In our FNAC series, the false positives has a rate of 23.5%. As the most advanced imaging method, ultrasonography (USG), computed tomography(CT) and magnetic resonance imaging (MRI) were performed in 13 (30.3%), 11 (25.5%) and 19 (44.1%) cases respectively. USG only was performed as the most advanced imaging method in 50% of the patients in 2008, however in 2018, 3 (75%) of the cases were evaluated with MRI and 1 (25%) case was evaluated with CT. Surgical excision of the cyst or fistula tract excision under general anesthesia was performed for treatment in all cases. Surgical pathology was consistent with branchial cyst or fistula in all cases. Superficial skin infection occurred in 2 (4.6%) patients in the postoperative period. No recurrence was detected in the follow-up period (0%). Conclusion: CT and MRI for imaging of second branchial cleft anomalies, and FNAC differentiation from other malignant cystic lesions has become more commonly used over the years. Surgical treatment is the treatment of choice for second branchial cleft anomalies. The complication and recurrence rates are very low with appropriate surgical excision.

Management of second branchial cleft anomalies

Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie, 2008

Branchial cleft anomalies are developmental disorders of the neck. The aim of this study was to evaluate the data of our patients, who have been diagnosed and treated for second branchial abnormalities in the last six years. We report our clinical experience in second branchial anomalies with a review of the literature. Our study is a retrospective one on a number of 23 patients hospitalized within 2001-2007 in ENT Clinic of Craiova for second branchial abnormalities in relation with age, gender, origin environment, clinical and paraclinical context in which the therapeutic decision was made, surgical procedures, post-surgical evolution. Among the anomalies of the second branchial arch, we encountered 10 (43.47%) patients with branchial cyst and 13 (56.52%) patients with branchial sinus. Twelve (52.17%) of the 23 patients were women and 11 (47.83%) were men; 9 (39.13%) patients were diagnosed and treated within the first age decade, seven (30.43%) within the second age decade, five ...

Branchial Cleft Cyst – A Misdiagnosed Developmental Anomaly

EMJ Oncology

Branchial cysts appear most often as unilateral neck masses and account for 25% of head and neck congenital swellings, of which 95% arise from the second branchial cleft. Here, the authors report a rare case of branchial cleft cyst in a 16-year-old girl, which is often misdiagnosed and treated improperly.

Type I second branchial cleft cyst in an adult patient

International Surgery Journal

Branchial cleft anomalies are rare diseases of head and neck region. Second branchial cleft anomalies represent more than 95% of all branchial cleft anomalies. Second branchial cleft cyst is a benign developmental cyst due to the incomplete obliteration of pharyngeal cleft. A 46-year-old female patient reported to hospital with a complaint of swelling over the left side of the neck since 4 to 5 months. On clinical examination, swelling was seen below and behind the angle of mandible on the left side. The patient was evaluated using ultrasound and contrast enhanced computerized tomography (CECT) of neck which revealed second left bronchial cleft cyst/enlarged cystic lymph-node. Fine needle aspiration cytology of the swelling showed features of cystic lesion. Type-I branchial cleft cyst is a rare condition with a significant risk of misdiagnosis. To avert misdiagnosis and surgical complications, thorough investigation must be performed prior to surgical intervention.

Importance and Impact of Appropriate Radiology in the Management of Branchial Cleft Anomalies

Indian Journal of Otolaryngology and Head & Neck Surgery, 2019

Branchial cleft anomalies are common differential diagnosis of neck masses. However, depending on the origin (1st, 2nd, 3rd or 4th arch), this pathology presents at different locations as cyst, sinus and fistula. Incomplete excision or incision and drainage of infected branchial cleft anomalies (cystic presentation) can lead to multiple recurrences. Appropriate radiology is imperative to make a correct diagnosis and to achieve complete excision to prevent recurrence. Our case series highlights the mode of presentation, appropriate radiology and management for each type of branchial cleft anomalies. Data of 27 patients with the diagnosis of branchial cleft anomaly and treated in the department of Otolaryngology-Head and Neck Surgery in a tertiary care referral centre in last 5 years was analysed retrospectively. Demographic data in terms of age, sex, laterality, clinical presentation, duration of symptoms and radiological investigations if any were recorded. The mean age at presentation was 22.1 years in this series of 27 cases including six (22.2%) recurrent cases. Most common clinical presentation was discharging sinus (59.25%) followed by cystic neck swelling (33.3%). Second branchial cleft anomalies were commonest (51.8%) followed by first branchial cleft anomalies (29.6%). Appropriate radiology was available for 17 (62.9%) patients. Branchial cleft anomaly is an important differential diagnosis of neck mass. Appropriate radiology helps in complete excision and prevents recurrences. Recurrent cases pose surgical challenge owing to fibrosis from previous surgery which further increases the chances of incomplete excision.

Branchial cleft cyst: A case report and review of literature

Journal of Oral and Maxillofacial Pathology, 2014

First branchial cleft anomaly is a rare disease of the head and neck. Because of its rarity, fi rst branchial cleft anomaly is often misdiagnosed and results in inappropriate management. In this article, we present a case of type II fi rst branchial cleft anomaly. A middle-aged woman who had suffered from swelling on lower jaw visited our department with the chief complaint of a swelling. She underwent complete excision of the lesion with preservation of the facial nerve. The patient recovered well and had no recurrence at 1-year of follow up.

First branchial cleft fistula: a case report

International Journal of Otorhinolaryngology and Head and Neck Surgery

First branchial cleft anomalies (BCA) are a rare finding in head and neck with incidence nearly- incidence of nearly 1 million per year which are distributed below external auditory canal, above the hyoid bone, anterior to sternocleidomastoid and posterior to submandibular triangle. First branchial cleft cysts are frequently misdiagnosed as they are rare and pose unfamiliar clinical signs and symptoms. Here we are reporting a case of surgical management of 1st branchial cleft fistula in a 5 years old male child from AIIMS, Raipur, Chhattisgarh, India as it’s a rare entity. Child presented with discharge from right upper part of neck. There was a swelling in right upper lateral part of neck with an opening also in floor of right external auditory canal (EAC). Contrast enhanced computed tomography of neck showed a 4.8 cm long obliquely oriented fistulous tract opening at junction of middle and upper one third of sternocleidomastoid with opening in right EAC. Surgical excision of the f...

Clinical Study of Second Branchial Cleft Anomalies

The Journal of craniofacial surgery, 2018

The objective of this study was to review the clinical characteristics and surgical treatment outcomes of second branchial cleft anomalies, and to evaluate the usefulness and accuracy of preoperative fine-needle aspiration cytology (FNAC) in the diagnosis of branchial cleft cysts. A retrospective chart review was performed at Chonnam National University Hwasun Hospital from January 2010 to December 2016. Among 25 patients with second branchial cleft anomalies, in 23 patients (92.0%), these anomalies presented as cysts, and in the remaining 2 patients (8.0%), these anomalies presented as fistulas. Fine-needle aspiration cytology had a diagnostic sensitivity of 100%, a positive-predictive value of 100%, and accuracy of 100% for diagnosing second branchial cleft cyst. All patients of second branchial cleft anomalies were treated surgically under general anesthesia. No recurrence of second branchial cleft anomalies was observed. Branchial cleft cysts were the most common type of second ...

Fourth branchial cleft anomaly: Management strategy in acute presentation

International Journal of Pediatric Otorhinolaryngology, 2014

Objectives: Branchial malformations are common congenital head and neck lesions usually diagnosed in childhood during the first decade of life. Acute presentation is usually managed with conservative protocols before a definitive surgical procedure although the risk of life-treating septic complications may influence the physician's decision. Surgery is the treatment of choice with the removal of the lesion alone, nevertheless more aggressive approaches must be considered in complicated cases. Selective neck dissection including the removal of part of the thyroid lobe with the congenital lesion should be considered as the "ultima ratio" treatment to avoid recurrence. Methods: We reviewed literature and report our experience concerning two patients with fourth branchial cleft sinus. Results: A three-year-old child with a clinical history of recurrent neck abscess was referred to our department after several drainages performed in another centre. A three-year-old child referred to our department for a left side lower primary neck abscess. In both cases the diagnosis of a complicated fourth cleft remnant was confirmed by rigid endoscopic visualization of the mucosal orifice of the sinus in the pyriform fossa. Surgical management during acute presentation was challenging; in one patient the early fasciitis required an emergency procedure to remove the infected sinus that were strictly adherent to the deep vascular-nervous axis. Conclusion: Surgery was the definitive treatment in both cases and at 12 and 25 months follow-up respectively no recurrences were observed.

Diagnostic and Operative Challenges in a Type I First Branchial Cleft Cyst: A Case Report

Cureus

First branchial cleft cyst (FBCC) is a rare entity of congenital anomalies in the head and neck area. Dealing with FBCC is a clinical challenge as the condition is frequently forgotten in the differential diagnosis of lateral neck swelling. We report a rare case of unilateral type I FBCC in an 11-year-old boy who presented with a painless and slow-growing preauricular mass masquerading as a benign cystic lesion of the parotid. The lesion was completely removed via surgical excision. Histopathology report confirmed the findings of squamous epithelium-lined cyst wall, which was a characteristic of a branchial cleft cyst. The combination of good clinical acumen, with the help of radiological correlation, along with a strong degree of suspicion for the condition, facilitates the diagnosis of this condition and hence proper management.