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.

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.

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.

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 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 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.

A Case of Branchio-Otic Syndrome / 대한이비인후과학회지

Branchio-oto-renal (BOR) syndrome is a clinically heterogeneous autosomal dominant form of syndromic hearing loss characterized by variable hearing impairment, malformations of the pinnae, the presence of branchial arch remnants, and various renal abnormalities. BOR syndrome is caused by mutations in EYA1 and SIX1, which are critical to organogenesis and are expressed together in developing otic, branchial, and renal tissue. Branchio-otic (BO) syndrome comprises branchial fistulas and preauricular pits, but lacks renal anomalies. We present a case of BO syndrome in 30year-old man with a review of the literature.

A Case of Non-Communicating Dumbbell Shaped Fourth Branchial Cleft Cyst / 대한이비인후과학회지

The fourth branchial cleft cyst is rare and frequently unknown to clinicians. Misdiagnosis is common and definitive surgery is often made difficult by previous episodes of infection and incision. We have experienced a case of non-communicating dumbbell shaped fourth branchial cleft cyst. We performed complete excision of the entire epithelial tract after disarticulating the cricothyroid joint. There was no recurrence.

A case of cervical branchial cleft cyst diagnosed with antenatal ultrasonography in fetus / 대한산부인과학회지

Cervical branchial cleft cysts are uncommon lesion that are developed from remnants of branchial apparatus in embryonal period. These cysts are found in infancy, childhood and adult by recurrent symptoms related to inflammation. It is difficult to find these cysts with antenatal ultrasonography and differential diagnosis from other cervical cysts is difficult too. We experienced a case of fetal cervical branchial cleft cyst that was found with antenatal ultrasonography and diagnosed with surgical biopsy, so we report our case with brief review of literatures.

A huge branchial cleft cyst detected prenatally: Differential diagnosis from other neck cystic lesions / 대한산부인과학회지

Though branchial cleft cysts (BCC) are common cause of congenital cyst formation in the neck, the prenatal cases have been reported very rarely. We discovered fetal neck cyst at 32 weeks of gestation and eventually diagnosed it as BCC by postnatal surgical excision and histologic findings. It is hard to establish differential diagnosis of BCC from other congenital neck cysts on fetal ultrasonography. The anatomic locations and clinical features of each cystic lesions are important to diagnose accurately and then to achieve complete surgical excision for recurrence-free treatment. We present a case of a BCC detected prenatally and survey the points of differential diagnosis of a BCC from other neck cystic lesions on fetal ultrasonography.

A Case of Squamous Cell Carcinoma Arising from Branchial Cleft Cyst / Oral Science International

Carcinoma arising from the remnant of branchial epithelium or branchial cleft cyst is known as branchiogenic carcinoma. It is very rare, and its existence is a matter of controversy. We report a case of cystic carcinoma of the upper neck that fully met Martin's criteria for branchiogenic carcinoma. A 53-year-old male visited Tsurumi University Dental Hospital with a swelling on the left side of the neck. Three tumors were excised from the neck, and histopathology revealed squamous cell carcinoma in a cystic lesion. As metastatic carcinoma of the cervical lymph nodes was suspected, the appropriate clinical tests and imaging were performed to determine the possible presence of a primary tumor. However, no primary carcinoma was found. These findings suggest that this was a case of branchiogenic carcinoma. The patient was treated with radiotherapy and followed up over an 8-year period. No evidence of recurrence was found.

Extirpation of First Branchial Cleft Cyst Preserving Superficial Lobe of Parotid Gland

Masses of the Parotid-Masseteric area can be caused by various different conditions, most commonly neoplasms of a benign nature. A rare cause for parotid tumors is the embryologic remnant of first branchial cleft cysts. A first branchial cleft cyst is an unusual clinical condition and is hard to be recognized. It is often misdiagnosed because its clinical feature is similar to what can be seen in other common diseases. So it may result in a diagnostic delay and insufficient and dangerous primary surgery. Definite surgical treatment of first branchial cleft cyst requires complete surgical excision, which usually necessitates identification and protection of the facial nerve and superficial parotidectomy. We report a case of first branchial cleft cyst that arose in parotid. We had a good aesthetic and functional result of surgical extirpation with sparing superficial parotid gland. There was no serious complication except temporary weakness of marginal mandibular branch of facial nerve.

Sonographic Detection of Intrathyroidal Branchial Cleft Cyst: A Case Report

We report here on an extremely rare case of an intrathyroidal branchial cleft cyst. Intrathyroidal branchial cleft cyst is rare disease entity and it has nonspecific findings on sonography, so the diagnosis of the lesion is very difficult. However, during aspiration, if pus-like materials are aspirated from a thyroid cyst, we should consider the possibility of intrathyroidal branchial cleft cyst in the differential diagnosis.

The Effectiveness of the Sclerotherapy of Benign Neck Cyst with the Use of OK-432 and 99% Alcohol / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In most cases of benign neck cysts, surgical excision has been considered the definite treatment. However, it is difficult to excise cysts completely in some cases. In view of this, non-surgical treatment for these lesions has been attempted with sclerosing agents. Some authors presented case reports on using OK-432 or 99% Alcohol sclerotherapy. In this study, we compared OK-432 and 99% Alcohol sclerotherapy with regards to effectiveness and complications associated in treating benign neck cyst. SUBJECTS AND METHOD: We retrospectively reviewed 29 patients who had undergone sclerotherapy with OK-432 or 99% Alcohol for benign neck cyst, such as ranula, lymphangioma, thyroglossal duct cyst and branchial cleft cyst. Information was gathered with respect to age, sex, number of injections, post-sclerotherapy side effects and outcome of treatments. RESULT: In the OK-432 sclerotherapy, 16 patients (69.6%) showed complete response, and 5 patients (20.7%) showed intermediate response. No response was seen in 2 patients (9.7%). In the 99% Alcohol sclerotherapy, 5 patients (83.3%) showed complete response, and 1 patient (16.7%) showed intermediate response. The side effects observed from intracystic injection therapy with OK-432 and 99% Alcohol were fever (55.2%) and localized pain (44.8%). In the OK-432 sclerotherapy, 18 patients (78.3%) had complications, In the 99% Alcohol, 3 patients (50%) had complications. However, these complications spontaneously disappeared after several days in all the cases. CONCLUSION: The results showed that OK-432 and 99% Alcohol injection is an effective and safe treatment for benign neck cyst. The effectiveness of OK-432 and 99% Alcohol injection is very similar.

Fine Needle Aspiration Cytology of the Branchiogenic Carcinoma: Report of A Case / 대한세포병리학회지

Development of an invasive squamous cell carcinoma within a branchial cleft cyst (branchiogenic carcinoma) is very rare and this case is the first description of cytologic findings in Korea. A 62-year-old man presented with a 5-month history of an enlarged right neck mass. Fine needle aspiration cytology of the mass showed low cellularity and the background containing proteinaceous debris, inflammatory cells, and histiocytes suggested a cystic nature. Abundant lymphocytes, a few anucleated squames, and rare atypical squamous cells with pyknotic nuclei and abnormal keratinization were also noted. After excision of the mass, histologic findings were consistent with a branchiogenic carcinoma. We recommend to raise the possibility of carcinoma (primary or metastatic) when we observe a few dyskeratotic cells in a cystic mass within the neck area, especially in an old male.

Parapharyngeal Second Branchial Cleft Cyst Extending to the Skull Base: A Lateral Transcranial Infratemporal fossa Approach

Branchial cleft cysts, sinuses, and fistulae are classified as first, second, third and fourth branchial cleft anomalies. They represent the congenital anomalies resulting from defects in the normal maturation of the branchial apparatus. Second branchial cleft anomalies occur more commonly than other branchial cleft anomalies. Most branchial cysts from the second branchial cleft are found deep in the sternocleidomastoid muscle or along its anterior border. Recognizing and diagnosing lateral neck cysts correctly are not difficult for an expert physician, although an unusual localization may cause problems in differential diagnosis. Complete excision of branchial cleft cysts is necessary to avoid recurrence. Approaches to the lesions are depending on the location and extent of the lesion. This article presents an unusual case of parapharyngeal branchial cleft cyst extending the skull base. Excision of the lesion was achieved via the lateral transcranial infratemporal fossa approach with zygomato-temporal craniotomy. This approach provides access not only to all of the subcranial tissues that underlie the middle cranial fossa, but to the maxillary or sphenoid sinus.

A case of oropharyngeal branchial cyst / 대한이비인후과학회지

A rare case of oropharyngeal branchial cyst in a fourteen-year-old boy is described. The cyst was located in the right lateral wall of the oropharynx. Histological examination revealed that the cyst was lined with a pseudostratified layer of the ciliated columnar epithelium and the lymphoid follicle. The position of the cyst and pathological feature were assumed to originate in the second branchial pouch.

Two Cases of Presumed Fourth Branchial Cleft Cyst in Neonate / 대한이비인후과학회지

A cystic mass of the neck causing neonatal respiratory distress is usually cystic hygroma. A branchial cleft cyst, however, also can cause respiratory distress on rare cases. The fourth branchial cleft cyst is very rare entity and, until now, only 35 cases have been reported worldwide. There have been some controversial attempts to prove its anatomical route through embryological background. Some reports, however, even suggested that it might be impossible to prove its entity anatomically. Recently, reports are coming out on the diagnostic approaches using not only anatomical pathway but also pathological impression. Authors experienced in neonates two cases of lateral cystic neck mass which were pathologically presumed to be fourth branchial cleft cyst. We are reporting these two cases with their diagnostic basis and the related literature.