Immediate to middle-term outcome of operation for children with first branchial cleft anomalies / 中国耳鼻咽喉头颈外科

OBJECTIVE To invest igate the immediate to middle-term outcome of operation for 22 children with first branchial cleft anomalies(FBCA). METHODS Twenty-two hospital ized cases who underwent s urgery for fi rst branchial cleft a nomalies f rom Jan. 2010 to Jan. 2017 were included in the study. Among them, 14 patients were male and the others were female. The median age at operation was 4.0 years old(11 months to 12 years old), and the weight of body was 14 kg(10 kg to 37 kg). There were 11 cases complicated with infection before operation. Eight patients had a history of incision and drainage. RESULTS Thirteen patients were diagnosed as Work Type I and the others were Type II. There were 2 cysts, 9 sinuses and 11 fistulas. All of the patients underwent surgery to remove the tract of FBCA. Based on the intraoperative anatomy, the tract ran superficial to the facial nerve in 15 cases, deep to it in 2 and passed between the branches in 5. There were no severe postoperative complications except 3 facial paralyses. At a median followup of 46 months (range from 7 to 84 months), one of the 3 patients with facial paralyses developed into normal and the other two became permanent. None of the patients had postoperative external auditory canal stenosis. There were 2 cases of recurrence who accepted a total of another three operations, and the others were free from reoperation. CONCLUSION Complete excision of the tract is the only way to cure FBCA, which has a close relationship with facial nerve. The surgical approach should be chosen according to the various types.

Hendidura congénita de la linea media diagnóstico y manejo quirúrgico / Congenital midline cervical cleft diagnosis and surgical management

"Introducción: la hendidura congénita de la línea media cervical es una patología infrecuente, con pocos reportes en la literatura mundial y con una incidencia menor del 2% dentro de las malformaciones congénitas. Su etiología está relacionada con defectos en la fusión de los primeros arcos branquiales. Los hallazgos clínicos de un cordón fibroso con compromiso cutáneo en la línea media cervical permiten establecer el diagnóstico de una forma temprana y precisa en la mayoría de los casos sin requerir otros estudios. Objetivo: presentar el caso de una paciente de 18 años con una lesión a nivel cervical en línea media sugestiva de un quiste del conducto tirogloso, así como la técnica quirúrgica empleada para su resección. Diseño: reporte de caso. Métodos: se realizó una nasofibrolaringoscopia sin hallazgos patológicos y una TAC de cuello contrastado que mostró un tracto fibroso a nivel sublingual, sin colección. Se llevó a resección de la lesión mediante disección completa del cordón. Discusión: el diagnóstico de la hendidura congénita de la línea media se basa en los hallazgos clínicos de la lesión y es confirmado histológicamente. La baja relación del quiste del conducto tirogloso con otras malformaciones hace que las ayudas imagenológicas sean en la mayoría de los casos innecesarias, y en caso de sospecharse, la ecografía de tejidos blandos cervicales es suficiente. Conclusión: el manejo quirúrgico es la piedra angular del tratamiento basado en su resección y corrección mediante Z-plastia. Su realización en edades tempranas minimiza la posibilidad de secuelas tanto funcionales como estéticas."

"Introduction: congenital midline cervical cleft is a rare pathology (less than 2% of congenital malformations) with very few reports in worldwide medical literature and a low incidence. Its etiology is related to defects in the fusion of the first branchial arches during embryologic development. Diagnosis is established through the clinical finding of a fibrous cord with cutaneous compromise on the cervical midline, with no need of additional complex or expensive tests. Objective: to present the case of an 18-year-old patient with a midline cervical lesion suggestive of a thyroglossal duct cyst; and to explain the surgical technique used for its resection. Design: case report. Methods: a nasofibrolaryngoscopy was performed without pathological findings and a contrast neck CT which showed sublingual a fibrous tract, without collection. A complete cord dissection was carried out. Discussion: The diagnosis of the congenital midline cleft is based on the clinical exam and confirmed through the histological findings after its resection. The low relation of the thyroglossal duct cyst with other associated malformations makes that the imaging aids are in most cases unnecessary, and in case of suspicion, cervical soft tissue ultrasound is sufficient. Conclusion: surgical management is the cornerstone of treatment based on the resection of the lesion and correction using the z-plasty technique. This surgery should be carried out at a young age in order to minimize the possibility of functional and aesthetic sequelae."

A Case of Second Branchial Cleft Sinus with Double Opening from the Tonsil / 대한이비인후과학회지

Second branchial cleft anomaly is the most common type of branchial anomalies. Tonsillitis can cause inflammation or infection through the cleft tract. We present an extremely rare case of a 15-year-old female with a tonsil sinus that caused a deep neck infection of the neck, showing a double-sinus opening. The patient was successfully treated with trichloroacetic acid chemocauterization.

A Case of Second Branchial Cyst in Retropharyngeal Space, Appearing as Dyspnea and Dysphagia / 대한이비인후과학회지

The authors report the clinical features of a huge retropharyngeal second branchial cyst in a 53-year-old woman. The patient showed acute exacerbation of dyspnea and dysphagia. On endoscopic examination and computed tomography (CT), a cyst-like lesion narrowing the oropharynx was observed in the right retropharyngeal space. However, a retropharyngeal abscess was also suspected on some CT images. A cystic mass was found and removed completely via exploration by trans-oral approach. According to the literature review, a branchial cleft anomaly mimicking retropharyngeal abscess is very rare.

A Case of Pyriform Sinus Fistula Concurrent with Papillary Thyroid Carcinoma in a 72-Year-Old Patient / 대한이비인후과학회지

Since branchial anomalies are developmental disorders, pyriform sinus fistula (PSF) has been considered as a pediatric disease, and most reports of PSF with clinical symptoms have thus been on neonatal and young children. There are only a few case reports worldwide, of PSF found in adult patients. Here, we report a case where the patient's initial symptom of PSF occurred at the age of 72. Interestingly, papillary thyroid carcinoma (PTC) was concurrently identified on computed tomography during the evaluation for PSF. Chemical cauterization and total thyroidectomy was performed for the treatment of PSF and PTC, respectively. This case report may contribute to increased awareness of PSF in adult patients and the possible coexistence of thyroid cancer in these patients.

Pyriform Sinus Fistula: A Single Center Experience / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pyriform sinus fistula with 3rd and 4th branchial cleft anomaly is an extremely rare congenital condition that is not very well understood owing to its rarity. The aim of the study was to review our experience with pyriform sinus fistulae to better understand them. SUBJECTS AND METHOD: Of 163 patients with branchial anomaly treated at our institute between 1999 and 2011, medical records of 15 patients with pyriform sinus fistula were retrospectively reviewed. RESULTS: Overall, 9.2% had pyriform sinus fistulae and this proportion was higher than that of patients with 1st branchial anomaly. The mean age at the time of initial symptom presentation was 11.9 years. However, five patients (33.3%) were not diagnosed at that time because pyriform sinus fistula was not suspected. Computed tomography (CT) was the most sensitive diagnostic tool in patients suspected to have pyriform sinus fistulae; the sensitivity of CT was 86.7%, whereas that for esophagography was only 20%. Conservative surgical treatment involving cauterization of the opening of the fistula tract was performed in nine patients and showed favorable results with 22.2% of recurrence rate during a mean follow-up period of 23.1 months. In 67.7% of the patients, the causative organisms were bacteria inhabiting human mouth, suggesting that infection source for pyriform sinus fistula may be food contents and discharge of upper aerodigestive tract. CONCLUSION: The incidence of pyriform sinus fistula may be higher than expected. Therefore, the possibility of pyriform sinus fistulae coexisting should be considered while treating young patients with perithyroidal infection.