The fourth branchial cleft deformity on the left anterior chest wall: a case report and literature review / 口腔疾病防治

Objective @#To explore the main points of clinical treatment of fourth branchial cleft deformity in special positions and to provide a reference for clinical practice. @*Methods@#The clinical data of one case of a fourth branchial cleft deformity that occurred in the left anterior chest wall with a fistula below the clavicle are summarized and combined with a literature review.@*Results@# The patient complained of repeated swelling and pain under the left anterior chest wall for 2 months. A 10 mm×10 mm fistula with yellow clear liquid exudate from the fistula was observed on the left side below the clavicle. A 20 mm×20 mm×10 mm swelling was immediately adjacent at the superficial cervicothoracic junction of the upper sternoclavicular joint, with no fluctuation and poor activity; this swelling produced slight pain upon pressing. Imaging examinations pointed to cystic lesions. The primary diagnosis was a fourth branchial deformity. A small amount of methylene blue was injected into the patient's subclavian fistula, and a supraclavicular T-shaped incision was made where the cyst contacted the fistula. By turning the flap, all the methylene blue-stained areas and adjacent submucosal tissues were exposed. During the operation, a mass was found on the sternum. The platysma was found deep in the notch, which was incised before excising the surrounding area. The pathological result is the fourth branchial cleft deformity. After 1 week and 3 months of follow-up, the patients had no discomfort and no recurrence. A review of the relevant literature shows that the fourth branchial cleft deformity is a congenital developmental abnormality that occurs in 1% of all branchial cleft deformity. It often presents as a fistula, cyst, or sinus tract and is anatomically located at the neck root and supravicular region. The fistula is close to the medial lower boundary of the sternocleidomastoid muscle. The diagnosis is often made based on its anatomical location, imaging examinations and, ultimately, pathology. The differential diagnoses include other cervical swellings, such as hemangioma and a thyroglossal duct cyst. Surgical resection is a commonly used treatment method. In recent years, endoscopic positioning and internal fistula burning have had good curative effects for recurrent fourth branchial cleft deformity, with a small chance of recurrence or cancer.@* Conclusion @#Given its unique position, clinicians should make full use of imaging methods to determine the size, anatomical location and course of the lesion when treating the fourth branchial cleft deformity to ensure the complete and safe surgical resection of the lesion and prevent recurrence.

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.

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.

The Combination Therapy of Chemocauterization and Electrocauterization on Fourth Branchial Cleft Cyst

BACKGROUND AND OBJECTIVES: Fourth branchial cleft cyst is a rare congenital anomaly which cause a recurrent cervical abscess. Complete excision of fourth branchial cleft cyst is difficult because of a complicated fistula tract. In addition to attempting chemocauterization with trichloroacetic acid (TCA) to avoid surgical complications, authors performed an electrocauterization to close internal opening of pyriform sinus. MATERIALS AND METHODS: We reviewed ten patients of fourth branchial cleft cyst underwent TCA chemocauterization and electrocauterization simultaneously. Clinical characteristics including patient informations, medical records, treatment results were analyzed retrospectively. RESULTS: Interval time until diagnosed with fourth branchial cleft cyst was variable from several days to decades. Five patients had a history of incision and drainage. Mean follow up period was 36.1 months and all patients were treated with no recurrence. CONCLUSION: TCA chemocauterization with electrocauterization can be a effective choice to reduce recurrence rate and ensure safety of patients of fourth branchial cleft cyst.

CT and MRI manifestation of branchial cleft fistula / 实用放射学杂志

Objective To discuss the diagnostic value of branchial cleft fistula with CT and(or)MRI.Methods CT and(or)MRI findings of 33 cases of branchial cleft fistula were collected and analyzed retrospectively.Results Branchial cleft fistula were divided into four types namely first,second,third and fourth according to its origin with each type having its own corresponding CT and MRI features.Among the 33 cases,7 cases (21%)were first branchial cleft fistula,which originated from external auditory meatus and the parotid gland.These lesions presented as a tubular structure around the ear,sometimes invading the facial nerve,causing facial nerve symptoms.1 8 cases (5 5 %)were second branchial cleft fistula,and were presented as tubular ones in the anterior triangle area of the neck or along the anterior border of the sternocleidomastoid muscle.8 cases (24%)were third or fourth branchial cleft fistula,which were difficult to differentiate,both of them originated from pyriform sinus and partly penetrated the thyroid.Conclusion CT and(or) MRI could show the location and range of the lesion clearly,making it valuable for diagnosis of branchial cleft fistula.

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."

Quiste de segundo arco branquial del espacio parafaríngeo en recién nacido: reporte de un caso / Second branchial cleft cyst parapharyngeal space in newborn: a case report

Dentro de los quistes cervicales congénitos los quistes branquiales son los segundos en frecuencia luego del quiste tirogloso, representando el 24% de los casos. De éstos, los quistes de segundo arco branquial son los más frecuentes con 90%-95% de los casos. Se presentan en un amplio rango de edad siendo comúnmente diagnosticados en niños mayores y adultos, cuya primera manifestación clínica puede ser un aumento de volumen relativamente brusco por infección. Se presenta el caso clínico de un recién nacido (RN) que debuta a las 48 horas de vida con estridor y dificultad para la alimentación oral. El estudio de imágenes con tomografía computarizada (TC) y resonancia magnética (RM) muestran una lesión quística del espacio parafaríngeo derecho que se proyecta hacia nasofaringe y orofaringe. Se realiza la exéresis de la lesión vía transoral. Biopsia rápida y diferida confirman diagnóstico de quiste branquial. Se revisa literatura sobre quistes de segundo arco branquial de ubicación en el espacio parafaríngeo siendo muy pocos los casos reportados.

Within the congenital cervical necks, the branchial cleft cyst are the second in the frequency after the shooting, accounting for 24% of the cases. Of the Second branchial cleft cyst are with the most frequent with 90-95% of the cases. It occurs in a wide range of ages and is commonly diagnosed in older children and adults, whose first clinical manifestation may be an increase in volume after infection. We present a clinical case of newborn that debuts at 48 hours of life with stridor and difficulty for oral feeding. The imaging study with Computed Tomography (CT) and Magnetic Resonance imaging (MRI) show a cystic lesion of the right parapharyngeal space projecting into the nasopharynx and oropharynx. The excision of the transoral lesion is performed. Frozen biopsy and diagnostic biopsy demonstrating a branchial cyst. We review the literature on the second branchial cleft cyst of the location in the parapharyngeal space with very few reported cases.

Excision of Second Branchial Cleft Cyst Via Retroauricular Approach without Assistance of Endoscopic or Robotic System / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Traditionally, the surgical approach for the excision of second branchial cleft cysts involves performing a transverse cervical incision on the skin overlying the mass. Recently, there has been a significant interest on the cosmetic outcomes of this surgery, and it has been found that the retroauricular approach produces better results. The purpose of this study was to evaluate the feasibility of a retroauricular approach for the excision of second branchial cleft cysts without the assistance of endoscopic or robotic system. SUBJECTS AND METHOD: From August 2013 to May 2016, a total of 12 patients with second branchial cleft cysts underwent surgery for the excision of the cyst via retroauricular approach, which involved an incision along the retroauricular sulcus and hairline. The surgical outcomes, complications, and subjective satisfaction with incision scars were assessed. RESULTS: In all 12 cases, the second branchial cleft cysts were removed successfully under direct vision and without the requirement of endoscopic assistance. The mean operation time was 80.3 min (range, 65-105 min). No significant complications were reported, such as skin flap necrosis, hematoma, seroma, or serious cranial nerve injury. The mean visual analogue scale score for subjective satisfaction with the incision scar was 8.8 (range, 7-10). CONCLUSION: The excision of second branchial cleft cysts via retroauricular approach without the assistance of endoscopic or robotic system is technically feasible and it provides a favorable cosmetic outcome.

A Case of Unusual Type of Branchial Cleft Cyst Presenting as Superficial Midline Neck Mass / 대한이비인후과학회지

The most widely accepted hypothesis about the origin of branchial cleft cysts (BCC) is developmental theory. The second most accepted is acquired inflammatory theory. A 57-year-old woman visited our department, presenting with a soft and well-margined round superficial mass in the lower midline neck. We performed an excisional biopsy to confirm the disease. The mass was located superficial to the sternohyoid without severe adhesion and abnormal communication. The pathology was proven to be BCC. We presumed that this is irrelevant to the established developmental theory, and a recurrent pharyngeal inflammation might lead to the transformation of aberrant epithelium into a cervical lymph node. We report rare and unusual type of BCC with a literature review. To the best of our knowledge, there have been two similar clinical cases that have been reported earlier.

Complete Fistula of the Second Branchial Cleft Managed by Single Neck Incision-our Experience and Review of Literature.

Introduction: Branchial fistulas and cysts, involving soft tissues of the neck, are quite uncommon anomalies of embryonic development that are commonly encountered by pediatric surgeons. Approximately 17% of all cervical masses in the pediatric age group are due to branchial anomalies. Although branchial cleft cysts are usually benign, infection, discharge, mass effect, and other surgical complications account for its morbidity. Aim: To assess 10 rare cases of a complete second branchial fistula which were diagnosed and treated in last 5 years by single neck incision in the Department of Surgery S. N. Medical College, Agra. Material and Methods: 10 cases of complete second branchial fistula were reported and managed in our institute. The age group of patients was from 2 to 12 months of age. These patients presented with an intermittent serous and mucoid discharge from an external opening in the lower aspect of the neck since birth. Most of the patients presented with opening on the right side of the neck. A pre-operative fistula gram done in all cases revealed the internal opening of tracts up to the peritonsillar fossa. In all cases, complete excision of the tracts was done by single step neck incision. Results: All the 10 patients underwent surgery with satisfactory results. Regular follow-up was done at biweekly for 1 month followed by monthly intervals up to 12 months. None developed any complications and no patient had recurrence. Conclusion: Although second branchial fistulae are common, complete fistulae with internal opening up to tonsillar fossa are rare, single step management of these cases merits the publication of this series. The report also guides on the need to perform a pre-operative fistulogram for the management of these cases.

Unusual Presentation of Second Branchial Cleft Cyst: Case Reports and Literature Review / 대한이비인후과학회지

Second branchial cleft cysts are the most common neck masses found in adults. However, the parapharyngeal presence of branchial cleft cyst is very rare. We report three cases of parapharyngeal branchial cleft cyst in adults. They suffered from frequent oropharyngeal infection or abscess. We performed a transoral resection without any surgical complications. Biopsy revealed a squamous lined epithelial wall with lymphoid aggregation, which is characteristic of branchial cleft cyst. No evidence of recurrence was observed in 2 years.

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.

Clinical analysis of 17 cases of giant infant branchial cleft cyst / 中国基层医药

Objective To summary the experience in the diagnosis and treatment of enormous infant bran-chial cleft cyst(EIBCC).Methods 17 cases of EIBCC inpatient were retrospectively analyzed,with the clinical char-acteristics,CT imaging materials.17 cases were treated with operation.The surgical operation was performed with the L curve of the external jugular incision.The the clinical effect was observed.Results The 17 EIBCC cases clinically appeared as difficult breathing in different degrees.The results of CT were consistent with the pathological diagnosis. There was no necrosis of the cervcal iskin flap.There was no post -operative recurrence after a half to 6 years following -up.Conclusion Dyspnea is the common clinical manifestation of EIBCC.Spiral CT is of great importance to diagnose the IBCC.Airway maintenance is the premise of safe cure.Surgical ablation is the main treatment of EIBCC.

Presentación de quiste de segundo arco branquial como masa orofaríngea: reporte de un caso / Second branchial cleft cyst presenting as oropharyngeal mass: a case report

La malformaciones de arcos branquiales constituyen la segunda causa de masa congénita de cabeza y cuello en niños. La presentación clínica depende del arco afectado, siendo las más frecuentes las de segundo arco branquial. Se presenta un caso clínico de un escolar de 7 años que consulta por disfagia lógica, evidenciándose una gran masa orofaríngea posterior a pilar faríngeo posterior izquierdo. El estudio de imágenes con tomografía computarizada (TC) y resonancia magnética (RM) de cuello mostró una lesión quística en relación al pilar faríngeo posterior izquierdo. Se realizó resección transoral de la lesión conservando su pared lateral. El estudio anatomopatológico resultó sugerente de quiste de segundo arco branquial. Se discute la presentación clínica, diagnóstico y alternativas de tratamiento de las anomalías de segundo arco branquial.

Branquial cleft malformations are the second cause of congenital mass of the head and neck in children. The clinical presentation depends on the cleft involved; second branchial cleft anomalies are the most common. There is a case of a 7 years old boy with a history of logic dysphagia, fisical examination shows a large oropharyngeal mass located behind the left posterior pillar of the pharynx. The imaging study with computed tomography (CT) and magnetic resonance imaging (MRI) of the neck showed a cystic lesion in relation to the left posterior pillar of the pharynx. Transoral resection of the lesion was performed keeping its lateral wall. Pathologic examination was suggestive of second branchial cyst. Clinical presentation, diagnosis and treatment options of the second branchial cleft anomalies are discussed.

A Case of Trichilemmal Cyst Invading Submandibular Gland / 대한이비인후과학회지

A trichilemmal cyst is a skin adnexal tumor that usually occurs on the scalps of elderly women. We report a trichilemmal cyst in the submandibular area of a 16-year-old male, masquerading as a second branchial cleft cyst. During surgery, the mass was found to have invaded the submandibular gland and needed to be excised totally in continuity with the submandibular gland. To our knowledge, this is the first reported case of a trichilemmal cyst involving the submandibular gland. Although rare, a trichilemmal cyst may be considered in the differential diagnosis of cystic lesions in the submandibular area. It should also be differentiated from other cystic malignant tumors for its tendency to invade the surrounding structure.

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.

A Case of Squamous Cell Carcinoma Arising in a Second Branchial Cleft Cyst / 대한이비인후과학회지

The existence of primary brancial cleft cyst carcinoma is controversial since first described by Volkmann in 1882. Martin and Khafif proposed criteria for diagnosis of primary branchiogenic carcinoma, which are now widely accepted in the literature. The most important criterion is the presence of squamous cell carcinoma arising from the benign squamous epithelium of branchial cleft cyst. We report a case of a 69-year-old man with branchial cleft cyst carcinoma, which was suspected to be cervical lymph node metastases from an unknown primary tumor. The subject underwent a surgical operation, and postoperative pathologic findings revealed a squamous cell carcinoma developing in the stratified squamous epithelial lining of the branchial cleft cyst. This case meets the criteria established by Martin and Khafif, thus we present it with a review of literature.

Collaural Fistula: A Case Report

Cervico-aural [collaural fi stula] fi stula is rare and it accounts for less than 5% of branchial cleft anomalies. In this paper, we report one such case of a 9 year old girl who was presented to us with two discharging cutaneous openings on the right side; one in the fl oor of the external auditory canal and another in the neck at the junction of the upper 2/3rd and lower third of the sternomastoid muscle along its anterior border.