Mini-incision with endoscope-assisted surgery for bilateral congenital second branchial cleft fistula and a pedigree report / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the feasibility and efficacy of mini-incision with endoscope-assisted resection for bilateral congenital second branchial cleft fistula, and to report on a rare pedigree. Methods: The clinical data of 5 patients with bilateral congenital second branchial fistula admitted in Fujian Provincial Hospital from April 2007 to December 2018 were retrospectively reviewed, including 2 males and 3 females, aged from 3 to 31 years old. The surgical strateges and clinical experience of single mini-incision with endoscope-assisted fistulectomy were summarized, and a rare pedigree was reported. Results: In five patients, Case 1 to Case 4 were treated with bilateral endoscopic-assisted fistula high ligation with titanium clips and removal through a single small incision under general anesthesia. No obvious complications occurred after the operation. The patients were followed up for 40-164 months with no fistula recurrence. Case 5 gave up surgical resection and was followed up for 24 months with acute infection attack once. Case 2 and Case 4 came from the same family. In this family, 7 out of 31 members of four generations had second branchial cleft fistulas, of which 4 were bilateral and 3 were right. Pedigree analysis was consistent with autosomal dominant inheritance. No deafness, preauricular tag, external and middle ear deformity and kidney malformation were found in the family members. Conclusions: Bilateral congenital second branchial cleft fistula is rare. Surgical resection is the preferred treatment. Mini-incision with endoscopic-assisted fistula high ligation with titanium clip and resection has clear operative field, ideal cosmetic effect and definite curative effect.

Manejo endoscópico de anomalías del cuarto arco branquial: reporte de tres casos / Endoscopic management of anomalies of the fourth branchial arch: report of three cases

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.

Braquio-dorso-mamoplastia: cirurgia do contorno corporal da região superior do tronco após grandes perdas ponderais / Brachial-dorsal mammoplasty: body contour surgery of the upper region of the trunk after major weight loss

INTRODUÇÃO: No Brasil foram realizadas 88 mil cirurgias bariátricas em 2014. Após o emagrecimento, ocorre desinsuflação de todo o tronco, com flacidez e dobra de excesso cutâneo das mamas à região dorsal posterior. Por isso, propomos procedimento cirúrgico que trate a região superior toda do tronco, incluindo mamas, dorso lateral e posterior e braços. OBJETIVO: Mostrar a experiência pessoal em cirurgias de braquio-dorso-mamoplastia. MÉTODO: Foram operados 13 pacientes no período de 2007 a 2014, sendo 11 mulheres e dois homens. RESULTADOS: A média de idade foi de 41,9 anos. A braquio-dorso-mamoplastia foi realizada em todos os pacientes. Em três casos, foi realizada braquio-dorso-mamoplastia em L, devido à menor deformidade latero-posterior. A duração média das cirurgias foi de 4 horas e 30 minutos. O Índice de Massa Corporal (IMC) médio, antes da cirurgia bariátrica, foi de 53,5 kg/m2. As perdas ponderais variaram de 47 a 114 kg. O IMC pré-operatório variou de 23 a 39 kg/m2. Não houve casos de infecção, grandes deiscências ou seroma. Duas pacientes evoluíram com hematoma, necessitando de nova intervenção para drenagem. CONCLUSÃO: As deformidades da região torácica no paciente com perda ponderal maciça são variáveis, sendo necessários diversos tratamentos cirúrgicos que deverão abordar o tórax inteiro como área anatômica única. É importante compreender a deformidade que cada paciente apresenta e adequar a abordagem cirúrgica em conformidade. A indicação principal para uma braquio-dorso-mamoplastia é a queda lateral do sulco inframamário.

INTRODUCTION: In Brazil, 88000 bariatric surgeries were performed in 2014. After weight loss, deflation occurs around the trunk, with sagging and folding of excess skin of the breasts in the posterior dorsal region . We, therefore, propose a surgical procedure to treat upper region of the entire trunk, including breasts, side and rear back, and arms. OBJECTIVE: To present a personal experience in brachial-dorsal mammoplasty surgeries. METHOD: We operated 13 patients from 2007 to 2014, 11 women and two men. RESULTS: The average age was 41.9 years. The brachial-dorsal mammoplasty was performed in all patients. In three cases, L-brachial-dorsal mammoplasty was performed, due to lower latero-posterior deformity. The average surgery duration was 4 hours and 30 minutes. The average Body Mass Index (BMI), before bariatric surgery, was 53.5 kg/m2. Weight loss ranged from 47 to 114 kg. The pre-surgery BMI ranged from 23 to 39 kg/m2. There were no cases of infection, large dehiscence or seroma. Two patients developed hematoma, requiring a new intervention for drainage. CONCLUSION: Deformities of the thoracic region in patients with large weight loss are variable, requiring several surgical treatments that should address the entire chest as a single anatomical area. It is important to understand the deformity that each patient presents and adapt the surgical approach accordingly. The main indication for a brachial-dorsal mammoplasty is lateral drop of the inframammary fold.

Fístula laterocervical izquierda de tercer arco branquial: caso clínico / Third left laterocervical fistula gill arch: case report

En el presente trabajo queremos describir un caso poco común de trayecto fistuloso cervical. Se presenta en un nino y nos parece importante a tener en cuenta como diagnóstico diferencial, dentro de la otorrinolaringología infantil. Las anomalías branquiales pueden presentarse como quistes, trayectos sinusoidales o fístulas. Se explican por un mal desarrollo del arco branquial durante el periodo embriológico. Se presentan principalmente en la infancia entre los 2 a 3 años de edad y a veces también en la juventud. Aparecen igualmente en ambos sexos. Las fistulas del primer arco branquial son raras (1%-8%), las más comunes son las del segundo arco (90%). En nuestra experiencia el método de imagen de elección para evaluar las anomalías de los arcos branquiales es la fistulografia. El tratamiento de todas ellas es la exéresis quirúrgica.

In this paper we describe a rare case of cervical fistula tract. It comes in a child and it seems important to consider in the differential diagnosis, in ORL child. Branchial anomalies can present as cysts or fistulas sinusoidal paths. Explained by poor development of gill arch during embryologic. They occur mainly in children between 2-3 years of age and sometimes in youth. Appear equally in both sexes. The first brachial arch fistulas are rare (1%-8%>), the most common are the second arch (90%%). In our experience the imaging method of choice to evaluate abnormalities of the brachial arches is the sinogram. Treatment is surgical removal.

Fissura congênita cervical da linha média / Congenital midline cervical left", "_e": "n

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.

Imaging of congenital anomalies of the branchial apparatus with surgical and pathological correlation

One of the most challenging topics for surgeons, pathologists and radiologists is congenital anomalies of the branchial apparatus that include fistulas, sinuses, cysts, and temporal bone anomalies. The aim of the study was to describe primarily the CT features of different abnormalities that are secondary to anomalous embryogenesis of the branchial apparatus with surgical and pathological correlation. This study included 30 patients with branchial apparatus anomalies, all evaluated clinically and radiologically with correlation of the imaging findings with the surgical and pathological results. Thirteen patients had first branchial apparatus anomalies; namely five classic first branchial apparatus anomalies, and eight temporal bone anomalies. Classic first branchial apparatus anomalies included two intra-parotid cysts, one intra-parotid sinus and two anterior triangle cysts. Temporal bone anomalies included three isolated external aural atresias, one isolated middle ear cleft anomaly, and four combined external auditory canal and middle ear cleft anomalies. Fifteen patients had second branchial apparatus anomalies; namely eight cysts, four sinuses and three fistulas. Only two third branchial apparatus anomalies were encountered including one cyst and one sinus. The anatomic location of different branchial anomalies was described in reference to their embryonic origin. Of the 13 branchial cysts included in this study, nine displayed well defined borders with fluid attenuation, and four displayed ill defined borders with heterogeneous mixed attenuation; correlated with infective and haemorrhagic changes. Three infected cysts displayed marginal enhancement. Magnetic resonance imaging was performed for eight branchial cysts with post-Gd acquisitions obtained for five of the cysts; MR imaging features matched the nature of the cysts. CT and MR imaging are crucial in the assessment of branchial apparatus anomalies to provide the surgeon with a detailed "road map" stressing the relationship of the lesion to critical neck structures

Congenital midline cervical cleft: a case report

A 4 months old baby girl was brought with the history of mucoid discharge from small midline defect on the ventral aspect of neck since birth. She had no other associated congenital defect. Family history of facial deformity such as cleft lip or palate or of thyroid disease was negative. On examination the lesion consisted of a cephalad skin tag, a mucosal surface and a caudal sinus in the midline of ventral neck between the chin and suprasternal notch. It was approximately 3 cm long and 1 cm wide. Sinogram of the lesion showed a blind tract going behind sternum. The patient was treated surgically and the cleft with its underlying fibrous cord that was attached with sternum excised. The vertical wound was closed with multiple Z plasties. On histological examination the cleft was partly lined by keratinized stratified epithelium with sebaceous gland and partly by non- keratinized stratified squamous epithelium. Underlying the epithelium were small collection of seromucous salivary glands. Surrounding tissue was densely fibrocollagenous and richly supplied with blood vessels. The post- operative course was uneventful. Patient is on follow up

Utilización peroperatoria del azul de metileno en patología quística del segundo arco branquial / Preoperatory utilization of the methylence blue in cystic pathology of the branchial second arcus

Reportar la técnica de coloración con azul de metileno de lesiones derivadas de los arcos branquiales como un método que facilita su disección. Descripción de dos casos clínicos en pacientes jóvenes con patología cervical. La evaluación clínica y los estudios preoperatorios confirmaron el diagnóstico de quistes branquiales del segundo arco, quienes sometidas a resección quirúrgica previa infiltración de la lesión con azul de metileno, procediendo a la disección del cuello según técnica habitual. Se observa la lesión y sus límites perfectamente coloreados, delimitando sus relaciones con las estructuras vecinas. La evolución posoperatoria fue satisfactoria. Los quistes branquiales constituyen la patología tumoral congénita del cuello más frecuente. Es de suma importancia la adecuada disección de la lesión ya que sus relaciones con las estructuras profundas del cuello hacen probable la lesión iatrogénica. La utilización del colorante permitió la disección y resección más segura con menor riesgo de lesión. La literatura relacionada es revisada

Afeccoes congenitas cervicais / Congenital neck affections

Os aspectos diagnosticos e terapeuticos das malformacoes congenitas cervicais sao discutidos com base na experiencia recente da Disciplina de Cirurgia de Cabeca e Pescoco da Faculdade de Medicina da Universidade de Sao Paulo. De 1993 a 1997, 100 pacientes foram submetidos a tratamento por afeccoes congenitas. A maioria foi composta de anomalias relacionadas ao ducto tireoglosso (54 por cento). Carcinoma papilifero em ducto tireoglosso, embora raro, foi encontrado em 2 casos. Os cistos e fistulas branquiais constituiram 19 por cento dos casos. O conhecimento dos fundamentos embriologicos determina a realizacao de tratamento adequado para essas afeccoes, com menor risco de recidiva

Anomalia da primeira fenda branquial: fístula cervical associada a supuraçäo do ouvido: apresentaçäo de um caso / Abnormality of the first branquial cleft: cervical fistula associated to ear supuration: report of a case

Os autores relatam um raro caso de criança portadora de anomalia originada da primeira fenda cervial cervical. Ela apresentava otorréia no ouvido esquerdo, em concomitância com a presença de um sínus servical. Após drenagem cirúrgica para tratamento do abscesso no triángulo anterior do pescoço, surgiu fístula que se manteve e colocou em comunicaçäo a pele com o assoalho do conduto auditovo externo. Comentam ainda a etiologia, incidência e tratamento cirúrgico