ABSTRACT
OBJECTIVE: To examine the accuracy of the pre-operative diagnosis of branchial cleft anomalies, and also to describe their occurrence, clinical presentation and management. METHODS: Retrospective review of the records of patients diagnosed with a branchial cleft anomaly between 1997 and 2006. RESULTS: One hundred and twenty-six patients were included. Pre-operative diagnosis had a positive predictive value of 0.856 (95 per cent confidence interval, 0.771-0.918) and a sensitivity of 0.944 (95 per cent confidence interval, 0.869-0.979). These patients' demographic data, investigations, findings and management are presented, along with a possible strategy for dealing with solitary cystic masses in the neck. CONCLUSION: As pre-operative diagnosis has a positive predictive value of 86 per cent, cystic lesions in the neck should be presumed to be carcinomatous until proven otherwise. Branchial fistulae and sinuses seem to be a disease of childhood, while branchial cysts occur mainly in adults. Branchial cleft anomalies are equally frequent in men and women, and equally distributed on the left and right side of the neck.
Subject(s)
Branchial Region/pathology , Branchioma/diagnosis , Fistula/diagnosis , Head and Neck Neoplasms/diagnosis , Preoperative Care/methods , Adolescent , Adult , Aged , Biopsy, Fine-Needle , Branchial Region/abnormalities , Branchial Region/surgery , Branchioma/pathology , Branchioma/surgery , Child , Child, Preschool , Diagnosis, Differential , Drainage , Female , Fistula/pathology , Fistula/surgery , Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/surgery , Humans , Male , Middle Aged , Predictive Value of Tests , Retrospective StudiesABSTRACT
AIMS: To describe the incidence trends, clinical presentation, management and outcome of acute epiglottitis in a Danish population after the introduction of Haemophilus influenzae type b vaccine. METHODS: Retrospective review of the health records of all patients discharged with a diagnosis of acute epiglottitis from the otolaryngology department, Roskilde County Hospital, Denmark, from 1996 to 2005. RESULTS: One infant and 34 adults were identified. The incidence of acute epiglottitis in children was 0.02 cases/100,000/year. Before introduction of the H influenzae type b vaccination (1983-1992), the mean national incidence of acute epiglottitis was 4.9 cases/100,000/year. The incidence of acute epiglottitis in adults was constant, with a mean value of 1.9 cases/100,000/year. Twenty-nine per cent of the patients required an artificial airway, and respiratory distress was found to be associated with airway intervention (p = 0.010). All patients recovered completely. CONCLUSIONS: In the H influenzae type b vaccine era, acute epiglottitis in children has almost disappeared. The incidence in the adult population has been constant. A discriminate approach to airway management seems safe in adults.
