ABSTRACT
Introdução: Os arcos branquiais são os precursores embriológicos da face, pescoço e faringe. As anomalias dos arcos branquiais são a segunda lesão congênita mais comum de cabeça e pescoço em crianças. Entre essas anomalias, estão os cistos de arcos branquiais (BCC), que surgem devido a uma incorreta obliteração das fendas branquiais, ainda no período embrionário. Os BCC podem ser assintomáticos, apenas percebidos incidentalmente, e não se manifestar até a idade adulta. Resultados: Anomalias do segundo arco branquial devem ser consideradas como um dos possíveis diagnósticos diferenciais de massas cervicais, especialmente as que se manifestam como um abaulamento em região lateral do pescoço. Os BCC são formações de revestimento epitelial, sem aberturas externas. Após seu diagnóstico, o tratamento é cirúrgico, usualmente por meio de uma incisão cervical transversa e cuidadosa dissecação das estruturas, com o objetivo de extirpar toda a lesão. Conclusão: O método descrito, de excisão da lesão, por meio de incisão transversa em região cervical, dissecção tecidual por planos e ressecção de massa cística, é uma opção para o tratamento dessa deformidade, com adequado resultado estético e boa reprodutibilidade.
Introduction: The branchial arches are the embryological precursors of the face, neck, and pharynx. Branchial arch anomalies are the second most common congenital head and neck lesions in children. Among these anomalies are branchial arch cysts (BCC), which arise due to incorrect obliteration of the branchial slits, still in the embryonic period. BCCs may be asymptomatic, only noticed incidentally, and not manifest until adulthood. Results: Anomalies of the second branchial arch should be considered as one of the possible differential diagnoses of neck masses, especially those that manifest as a bulge in the lateral region of the neck. BCCs are epithelial lining formations without external openings. After diagnosis, treatment is surgical, usually through a transverse cervical incision and careful dissection of the structures, with the aim of extirpating the entire lesion. Conclusion: The method described of excision of the lesion through a transverse incision in the cervical region, tissue dissection in planes, and resection of the cystic mass is an option for the treatment of this deformity, with adequate aesthetic results and good reproducibility.
ABSTRACT
Introdução: Os cistos branquiais são tumores congênitos laterais, resultantes de defeitos de desenvolvimento embrionário que afetam os arcos branquiais.1 As anomalias congênitas cervicais são mais comumente diagnosticadas nos primeiros anos de vida. Objetivo: Informar, discutir e analisar condutas para tratamento desse tipo de cisto congênito. Método:Relato de caso e análise de dados, diagnósticos e conduta baseada na literatura referente a Cisto Branquial da 4° Fenda. Resultados:Os cistos podem se manifestar tardiamente, mas as fístulas são, quase sempre, diagnosticadas ao nascimento ou na infância.São extremamente raros, estima-se que 95% das anomalias das fendas branquiais sejam da 2ª fenda; das 5% restantes, quase todas são da 1ª ou 3ª fenda.O diagnóstico é primariamente clínico, mas a ultrassonografia pode auxiliar no diagnóstico diferencial de um cisto branquial. O tratamento das anomalias branquiais é a excisão cirúrgica. Lactente sexo feminino, 9 meses de idade em acompanhamento de cisto branquial com conduta conservadora. O surgimento da massa se deu logo ao nascimento, havendo drenagem espontânea do cisto para o esôfago alguns dias depois. Após nove meses paciente retorna devido aumento progressivo da lesão que correlacionando com exame físico, exames de imagem levaram ao diagnóstico de cisto de 4º fenda branquial. Realizada cirurgia para remoção de Cisto juntamente com retirada de lobo esquerdo da tireoide (tireoidectomia parcial). Conclusão:Após a exerese da lesão paciente evoluiu satisfatoriamente sendo encaminhado para enfermaria e posteriormente alta com acompanhamento ambulatorial com pediatra geral.
Introduction: Branchial cysts are congenital tumors, resulting from embryonic defects that affect the branchial arches. Congenital cervical abnormalities are usually diagnosed in the first years of life. Objective: To inform, discuss and analyze treatment approaches for this type of congenital cyst. Method: Case report and analysis of data, diagnoses and approaches based on the literature addressing Fourth Branchial Cleft Cysts. Results: Cysts can manifest late, but fistulas are almost always diagnosed at birth or in childhood. They are extremely rare: it is estimated that 95% of branchial cleft anomalies involve the second cleft; of the remaining 5%, almost all arise from the first and third clefts. There are about 45 cases of fourth cleft cysts reported in the literature. The diagnosis is primarily clinical, but the ultrasound can be used for the differential diagnosis of a branchial cyst. Computed tomography will show air-fluid level in the anterior portion of the neck, in front of the thyroid and trachea, which may compress the trachea, causing respiratory distress in childhood. The treatment of branchial anomalies is surgical excision. A 9-month old female patient was being followed up after conservative treatment of a cervical mass (branchial cyst). The cyst appeared immediately after birth, but there was there was spontaneous drainage of the cyst into the esophagus a few days later. After nine months, the patient returned due to a progressive increase of the lesion, which, after physical examination and imaging exams, led to the diagnosis of a fourth branchial cleft cyst. A surgical procedure was performed to remove the cyst along with the left thyroid lobe (partial thyroidectomy). Conclusion: After the excision of the lesion, the patient made a good recovery. She was then referred to the infirmary and later discharged with outpatient follow-up by a general pediatrician.
ABSTRACT
Las anomalías de las hendiduras y arcos branquiales son la segunda causa más común de lesiones congénitas de cabeza y cuello en niños. Representan el 8% de todas las malformaciones congénitas y el 30% de las de cabeza y cuello. Pueden permanecer asintomáticas o manifestarse como una tumefacción y asociarse a infecciones recurrentes supuradas en la región preauricular, subauricular o retroauricular, en las regiones de la parótida y/o del cuello. Fueron reportados casos asociados a malformaciones óticas.La tomografía computada de alta resolución y la resonancia magnética con gadolinio pueden ayudar al diagnóstico. El tratamiento médico antibiótico está indicado ante una infección aguda, además de incisión y drenaje en los procesos abscedados. El tratamiento definitivo es quirúrgico con la extirpación completa de la lesión. Se presenta a un niño de 6 años de edad con infección aguda en la región retroauricular derecha en el oído disgenésico
Branchial cleft anomalies are the second most common congenital head and neck lesions in children. The first congenital head and neck lesion is thyroglossal duct cysts. First branchial cleft anomalies are rare congenital head and neck malformations (8% of branchial cleft anomalies).The initial clinical manifestation was recurrent infections and/or discharge in auricular, periauricular, parotid or upper neck regions. These anomalies are extremely rare and other associated facial malformations were described.The computed tomography and magnetic resonance can help the diagnosis. The antibiotic treatment is indicated in acute infection. Also, incision and drainage are recommended in abscessed processes.In this report, we present a case of retroauricular sinus infection in a 6-year-old child with congenital ear anomalies
Subject(s)
Humans , Male , Child , Branchial Region/abnormalities , Fistula/diagnostic imaging , Congenital Abnormalities , Ear, External , Fistula/surgeryABSTRACT
Objective@#To summarize the experience of the diagnosis, treatment and effects of the cases with coexistence of first branchial cleft anomaly(FBCA) and microtia with congenital aural atresia or stenosis(external auditory canal stenosis, EACS).@*Method@#This was a retrospective study. The clinical data of 5 patients with microtia and EACS in Beijing Tongren Hospital of Capital Medical University from October 2015 to March 2018 were collected, including 3 males and 2 females, aged from 5 to 28 years. The clinical characteristics, imaging findings, treatment methods and effects of 5 patients were analyzed.@*Result@#The 5 cases were all coexistence of EACS and FBCA, three of who associated with cholesteatoma of external auditory canal. CT showed external auditory canal stenosis with soft tissue shadow, sometimes gas or bone septum found inside, filling in the external auditory canal, combined with canal bone destruction irregularly. All patients underwent surgical resection of FBCA, 3 patients accompanied by cholesteatoma resection and canalplasty. The postoperative follow-up ranged from 10 to 39 months, and no recurrence of infection was observed.@*Conclusions@#EACS and FBCA both result from maldevelopment of the first branchial cleft. These two malformations, FBCA and EACS with or without cholesteatoma, can occur simultaneously, in which situation CT shows external auditory canal stenosis with soft tissue shadow inside. These patients underwent surgical resection of FBCA combined with cholesteatoma resection with good result.
ABSTRACT
Las anomalías de cuarto arco branquial corresponden a una entidad patológica infrecuente. Para su manejo existen distintas alternativas terapéuticas siendo una de ellas la cauterización endoscópica. Reportamos 3 casos de senos de cuarto arco branquial tratados mediante cauterización endoscópica en el Hospital Regional de Concepción luego de una revisión de fichas clínicas de todos los pacientes con diagnóstico de anomalías de cuarto arco branquial. Se identificaron tres casos de senos de cuarto arco branquial. Todos corresponden a pacientes de sexo masculino que presentaron cuadro de absceso cervical, diagnosticándose 2 de ellos al presentar recurrencia. Todos fueron tratados mediante cauterización endoscópica de la apertura fistulosa en seno piriforme. Estas anomalías representan vestigios de un trayecto que se origina desde el vértice del seno piriforme. La cauterización endoscópica presenta una serie de ventajas con tasas de recurrencia similares a la cirugía abierta de cuello, menores tasas de complicaciones y costo económico. Las anomalias de cuarto arco branquial constituyen una patología infrecuente y el diagnóstico requiere alta sospecha clínica. El manejo endoscópico ha demostrado ser una alternativa segura y efectiva con menor tasa de complicaciones.
Anomalies of the fourth branchial arch correspond to an uncommon pathological entity. There are different therapeutic alternatives being one of them the endoscopic cauterization. We report 3 cases of fourth branchial arch anomalies treated by endoscopic cauterization in the Regional Hospital of Concepción. Review of clinical records of all patients with diagnosis of fourth branchial anomalies operated by endoscopic cauterization at the Regional Hospital of Concepción. Cases: Three cases of fourth branchial arch sinus were identified. All of them were male patients who presented with a cervical abscess, diagnosing 2 of them when they recurred. All 3 cases were treated by endoscopic cauterization of the fistulous opening in the piriform sinus. These anomalies represent vestiges of a path that originates from the apex of the piriform sinus. Endoscopic cauterization presents a number of advantages with recurrence rates similar to open neck surgery, with lower complication rates and economic cost. Fourth branchial anomalies constitute an uncommon pathology and the diagnosis requires high clinical suspicion. Endoscopic management has proven to be a safe and effective alternative with a lower rate of complications.
Subject(s)
Humans , Male , Child, Preschool , Child , Adolescent , Branchial Region/abnormalities , Branchial Region/surgery , Respiratory Tract Fistula/surgery , Endoscopy/methods , Cautery , Abscess/surgeryABSTRACT
Objective@#To investigate the relationship between Work Ⅱ type of congenital first branchial cleft anomaly (CFBCA) and facial nerve and discuss surgical strategies.@*Methods@#Retrospective analysis of 37 patients with CFBCA who were treated from May 2005 to September 2016. Among 37 cases with CFBCA, 12 males and 25 females; 24 in the left and 13 in the right; the age at diagnosis was from 1 to 76 ( years, with a median age of 20, 24 cases with age of 18 years or less and 13 with age more than 18 years; duration of disease ranged from 1 to 10 years (median of 6 years); 4 cases were recurren after fistula resection. According to the classification of Olsen, all 37 cases were non-cyst (sinus or fistula). External fistula located over the mandibular angle in 28 (75.7%) cases and below the angle in 9 (24.3%) cases.@*Results@#Surgeries were performed successfully in all the 37 cases. It was found that lesions located at anterior of the facial nerve in 13 (35.1%) cases, coursed between the branches in 3 cases (8.1%), and lied in the deep of the facial nerve in 21 (56.8%) cases. CFBCA in female with external fistula below mandibular angle and membranous band was more likely to lie deep of the facial nerve than in male with external fistula over the mandibular angle but without myringeal web.@*Conclusions@#CFBCA in female patients with a external fistula located below the mandibular angle, non-cyst of Olsen or a myringeal web is more likely to lie deep of the facial nerve. Surgeons should particularly take care of the protection of facial nerve in these patients, if necessary, facial nerve monitoring technology can be used during surgery to complete resection of lesions.
ABSTRACT
Objective@#To investigate the usefulness and effectiveness of multi-slice spiral computerized tomographic fistulography (MSCTF) in the diagnosis and treatment of congenital fistula of neck.@*Methods@#Thirty-four patients with thyroglossal fistulasor branchial cleft fistulas who were initial treated from July 2008 to August 2015 in Fujian Provincial Hospital were retrospectively analyses. Thirteen males and 21 females patients aging from 3 to 46 years old with a median age of 37 were included. There were thyroglossal fistula in 6 cases, the first branchialcleft fistula in 9 cases, the second branchialcleft fistula in 3 cases, the third branchialcleft fistula in 9 cases, and the fourth branchialcleft fistula in 7 cases. All the patients underwent preopeative MSCTF and the diagnoses were finally confirmed with surgery and histopathology. Multiplanar reconstruction(MPR), maximumintensity projection(MIP)and volume rendering(VR) were completed with AW Volume Share 4.2 image processing software after initial CT scanning.The internal openings, distribution, and neighboring relationship of the fistulas showed by MSCTF were analyzed and the surgical strategies were subsequently made.@*Results@#Except 2 cases, 32 patients had obtained successfully MSCTF image. The presence and location of the fistulas could be showed clearly on MSCTF. Based on the results of MSCTF examination, the surgical planes to treat the fistulas were made. The fistulas in all cases were successfully found and excised. Three cases underwent selective neck dissection. Postoperative infection occurred in 1 case. Unilateral vocal fold paralysis due to surgery recovered 3 months after surgery with follow-up. One case lost follow-up, the remaining 33 cases were followed up for 13-97 months with no the fistula recurrence.@*Conclusions@#MSCTF could provide valuable information and benefit surgical planning by demonstrating the coursesof congenital fistulas of neck in detail.
ABSTRACT
Preauricular sinus is a congenital malformation that is very commonly encountered among the general population and it has especially high prevalence among Asians when compared to other ethnic groups. It can often go unnoticed or easily overlooked by the patient or even by doctors because most of them are asymptomatic and is most of the time only a tiny pit that can be trivial in terms of aesthetics. We report a very rare and unique case that has no precedence what so ever; hence no reported case in the literature: an ectopic preauricular sinus in a facial cleft and microsomia patient.
Subject(s)
Humans , Asian People , Branchial Region , Congenital Microtia , Craniofacial Abnormalities , Esthetics , Ethnicity , PrevalenceABSTRACT
Preauricular sinus is a congenital malformation that is very commonly encountered among the general population and it has especially high prevalence among Asians when compared to other ethnic groups. It can often go unnoticed or easily overlooked by the patient or even by doctors because most of them are asymptomatic and is most of the time only a tiny pit that can be trivial in terms of aesthetics. We report a very rare and unique case that has no precedence what so ever; hence no reported case in the literature: an ectopic preauricular sinus in a facial cleft and microsomia patient.
Subject(s)
Humans , Asian People , Branchial Region , Congenital Microtia , Craniofacial Abnormalities , Esthetics , Ethnicity , PrevalenceABSTRACT
BACKGROUND: Accessory tragus is an abnormal ear structure that has the shape of a nodule or a papule. The existing surgical method is very simple, wherein an elliptical incision is made around the lesion and the underlying cartilage is removed. However, this method may leave a depressed or dimpled scar and may cause chondrodermatitis. METHODS: We corrected the accessory tragus by a new method using triangular flaps, and the procedure was performed in eight patients. Out of the four triangular flaps, which were created by drawing lines that connected the left and the right sides and the superior and inferior surfaces of the accessory tragus and quartering them, two flaps that faced each other were excised. Once the cartilaginous tissue inside was verified and removed up to the base to the greatest extent possible, the remaining two triangular flaps were sutured and the remaining skin margin of the flap was trimmed. RESULTS: None of the patients had any wound problems related to the surgery, and none of them complained of chondrodermatitis up to 6 months postoperatively. No depression or dimple was observed externally up to 6 months after the operation, and the z-shaped scar, which was created by the crossing over of the triangular flaps, was not as visible as a linear scar. CONCLUSIONS: Correction of an accessory tragus by using the triangular flaps introduced in this study provides a wider operative view through a smaller incision, while preventing the formation of dimples or a depression after the operation.
Subject(s)
Humans , Branchial Region , Cartilage , Cicatrix , Congenital Abnormalities , Crossing Over, Genetic , Depression , Ear , Methods , Skin , Surgical Flaps , Wounds and InjuriesABSTRACT
Existe uma deformidade cervical da linha média que tem sido descrita com vários nomes. Embora sua causa embriológica continue sendo controversa, a etiologia mais aceita até hoje é a falha da fusão na linha média dos arcos branquiais distais. A característica principal é uma lesão protuberante na linha média da região anterior do pescoço, entre o mento e a fúrcula esternal. Recomenda-se a ressecção cirúrgica completa da lesão, e a reconstrução do defeito com w-plastia ou zetaplastia. Neste artigo, é relatado o caso de uma paciente de 38 anos, com fissura congênita cervical da linha média. Após exérese da lesão, foi realizada zetaplastia simples, obtendo-se bom resultado tanto estético como funcional. As fissuras congênitas cervicais da linha média são alterações raras na população mundial, porém seu diagnóstico precoce e tratamento cirúrgico adequado são necessários para prevenir alterações no crescimento facial e restrição na extensão do pescoço.
Congenital midline cervical cleft is a deformity known by several names. Although its embryologic origin has not been clearly established, the most widely accepted etiology is impaired midline fusion of the distal branchial arches. The main characteristic of this malformation is a protruding lesion at the midline of the anterior neck, between the chin and the suprasternal notch. Complete surgical resection of the lesion is recommended, with repair of the defect using W-plasty or Z-plasty. This article reports the case of a 38-year-old patient with congenital midline cervical cleft. A simple Z-plasty was carried out after excision of the lesion, and a satisfactory aesthetic and functional result was achieved. Congenital midline cervical cleft is a rare abnormality; however, early diagnosis and appropriate surgical treatment are necessary to avoid changes in the development of the face and limitation of neck extension.
Subject(s)
Humans , Female , Adult , Neck Pain/surgery , Maxillofacial Development , Neck/surgery , Plastic Surgery Procedures , Branchial Region/abnormalities , Branchial Region/surgery , Esthetics , Methods , PatientsABSTRACT
Goldenhar syndrome is a sporadic or inherited genetic syndrome characterized by limbal dermoids, preauricular skin tags and mandibular hypoplasia. Vertebral abnormalities may occur. The incidence of this syndrome ranges from 1 in 5,600 to 1 in >20,000 live births. It consists of abnormalities involving the first and second branchial arches. The etiology of the syndrome is heterogeneous. Diagnosis should be based principally on clinical aspects, which should be associated with the patient's systemic conditions and radiologic findings. Treatment depends on the patient's age and systemic manifestations, with a multidisciplinary approach often being required.
A síndrome de Goldenhar é uma síndrome genética esporádica ou hereditária caracterizada por dermóides epibulbares, apêndices auriculares e hipoplasia mandibular. Anormalidades vertebrais podem ocorrer. A sua incidência varia de 1 para 5600 a 20000 nascidos vivos e consiste em anormalidades que envolvem o primeiro e segundo arcos faríngeos. A etiologia da síndrome é heterogênea. O diagnóstico deve ser feito baseado principalmente nos aspectos clínicos e associado tanto com as condições sistêmicas quanto com os achados radiológicos. O tratamento depende da idade e das manifestações sistêmicas geralmente necessitando de acompanhamento multidisciplinar.
Subject(s)
Child , Female , Humans , Goldenhar Syndrome/diagnosis , PhenotypeABSTRACT
The branchial cleft anomaly is found in the cervical mass, rising usually from an incomplete obliteration of the branchial apparatus during fetal development. This anomaly might be confused with and mistaken for other potentially more serious lesion, such as cystic hygromas, teratomas, and lymphomas. The abnormality is typically revealed in the pediatric and adolescent population and is unilateral; bilateral manifestations are rare. We present a case of bilateral second branchial cleft sinus in a 21-year-old woman with a review of the literature.
Subject(s)
Adolescent , Female , Humans , Young Adult , Branchial Region , Fetal Development , Lymphangioma, Cystic , Lymphoma , TeratomaABSTRACT
The fourth branchial pouch sinus is a developmental anomaly which most freqently manifests itself by recurrent episodes of neck abscess or acute suppurative thyroiditis. The most common developmental anomalies of the branchial apparatus are second cleft remnant, which constitute almost 95% of all anomalies. The remaining 5% are comprised almost exclusively of first and third arch remnants. So the fourth arch remnants are exceedingly rare. A high index of suspicion, combined with barium swallow pharyngogram and computed tomography scan can aid in diagnosis. Complete excision of the entire epithelial tract combined with ipsilateral thyroid lobectomy remains the mainstay of treatment. Authors experienced a case of lateral neck mass which was pathologically presumed to be the fourth branchial pouch sinus. We report this case with the related literature.
Subject(s)
Abscess , Barium , Branchial Region , Diagnosis , Fistula , Hypopharynx , Neck , Thyroid Gland , Thyroiditis, SuppurativeABSTRACT
BACKGROUND AND OBJECTIVES: The branchial anomaly is a lateral neck mass commonly seen by otolaryngologists. Although somewhat controversial, almost all surgeons agree that lateral cervical cyst, fistula and sinus are of branchogenic origin. Depending on its anatomic location, branchial anomaly can be classified into first, second, third and fourth. The purpose of this study is to evaluate the clinical and pathologic manifestations of branchial anomaly and to determine proper diagnosis and treatment. MATERIALS AND METHOD: With a review of charts, we retrospectively analyzed 46 cases of the branchial anomaly who had been treated at the Hanyang University Medical Center between 1991 and 2001. Age, sex, site of lesion, classification, surgical therapy, radiologic and pathologic findings and post-operative surgical complications were reviewed. RESULTS: The second branchial cyst was the most common anomaly. Patients were commonly seen in the 3rd and 4th decades. Compared with cysts, the fistulas and sinuses were detected relatively at the younger age. Twenty five per cent of patients were presented in the infected state, and 45 cases were treated with complete surgical excision; there were no major post-operative complications and recurrence. CONCLUSION: An accurate diagnosis is crucial in the management of branchial anomaly to prevent recurrence and multiple surgical procedures. Although clinical examination and history are the most important factors suggesting the diagnosis of branchial anomaly, preoperative radiologic evaluation can be used to determine the nature and extent of the branchial anomaly. After control of acute inflammation or abscess, the complete surgical excision is crucial for a successful outcome.
Subject(s)
Humans , Abscess , Academic Medical Centers , Branchial Region , Branchioma , Classification , Diagnosis , Fistula , Inflammation , Neck , Recurrence , Retrospective StudiesABSTRACT
Second branchial cleft cysts are the most common type of branchial abnormalities and usually found high in the neck. Oropharyngeal presence of branchial cleft cyst is very rare. We report a case of oropharyngeal branchial cleft cyst in 2-yr-old girl with about 1x1 cm sized cystic mass, which had not any specific symptom. It was removed completely under impression of mucocele and did not have tract-like structure. However, cyst had a squamous epithelium-lined wall with lymphoid aggregation in histopathologic study, which was characteristic finding of branchial cleft cyst. Patient discharged without any complication and there was no evidence of recurrence for 18 months follow-up. We review reported oropharyngeal or nasopharyngeal presentation of these cases in English literature and embryological explanation.