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Head and neck surgery
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
The pathogenesis of branchial cleft anomalies is controversial, and may occur as any combination of sinus, fistula, and cyst. Incomplete obliteration of the branchial apparatus, primarily the cleft, is accepted as the most likely etiology. Most branchial anomalies arise from the second branchial apparatus as the second branchial arch overgrows the second, third, and fourth branchial clefts, and finally fuses with the lateral branchial wall. As the arches coalesce during the growth of the embryo, part of the first branchial cleft remains open as the Eustachian tube and auditory canal. The second branchial cleft normally closes completely; however, either branchial cleft may form a sinus tract or cyst as it coalesces.
Neck
Published in Swati Goyal, Neuroradiology, 2020
Spectrum of branchial apparatus anomalies results from incomplete obliteration, proliferation, or migration of one of the four branchial clefts: BC cyst – no internal or external communicationBC fistula – has both internal and external communicationsBC sinus – opens internally (most commonly) or externally, with closed portion ending as a blind pouch
Congenital neck lumps
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
The branchial or pharyngeal arches first appear in the fourth week of gestation. The branchial system consists of arches, internal pouches and external grooves or clefts from which head and neck structures develop in utero (see Table 4.2). The branchial apparatus relates to a series of gill-like slits which are similar to those that develop into gills in fish, hence the name branchial meaning ‘gills’ in Greek [17].
Bilateral second branchial cleft fistulae coexisting with bilateral pre-auricular fistulae: A rare case report
Published in Acta Oto-Laryngologica Case Reports, 2020
Hongli Gong, Chunping Wu, Liang Zhou, Lei Tao
Pre-auricular fistulae were also observed in our case but did not undergo surgical treatment. Singh et al. [6] reported a case of bilateral first arch anomalies co-existing with bilateral second arch anomalies previously. Most congenital malformations in the neck are connected to the branchial apparatus. One interesting condition is that bilateral branchial cleft fistulae may be connected to pre-auricular fistula, while this correlation is weak and required confirmation by future studies. A pre-auricular fistula is embryologically connected to the incomplete involution of first branchial apparatus, and is failure fusion of the hillocks of His that condense and unite to form the auricle during sixth week of gestation [1,6]. The malformation of pre-auricular fistula is different from those of first branchial cleft anomalies that include two types of lesions and pass close to the parotid gland and facial nerve. Type I is duplication of the membranous external auditory canal and contains ectodermal elements, and course lateral to the facial nerve. Type II consists of ectoderm and mesoderm tissues and passes medial to the facial nerve [1,6]. Since there was no history of infection with the pre-auricular fistulae, the patient and his family decided to tolerate this inconvenience and refused definitive excision after our discussion.
Evaluation of endoscopic coblation treatment for obliteration of congenital pyriform sinus fistula
Published in Acta Oto-Laryngologica, 2018
Lulu Wang, Jianzhong Sang, Yamin Zhang, Liuzhong Wang, Wendan Gong, Hua Cao
Fourth branchial arch anomalies were first described by Tucker and Skolnick in 1973 [7]. Congenital pyriform sinus fistula is a rare branchiogenous disease of the neck that may be associated with an incomplete obliteration of the third or fourth branchial pouch. In more than 80% of the patients, the onset occurs during childhood or young adulthood, and the incidence of males and females is equal [8]. The higher proportion of males in our study may be related to the higher proportion of males in China. Left predominance accounted for 97.3% of the cases in our study. Normally, embryology of the branchial apparatus presents that the fourth arch artery on the left side becomes the part of the aortic arch during development, while the fourth arch artery on the right side becomes the proximal portion of the right subclavian artery. This asymmetric development of branchial apparatus may explain the cause of the left-sided predominance of pyriform sinus fistula [9,10]. Because pyriform sinus fistula is a rare entity, few studies in the literatures have more than a handful of patients. The series presented herein stands for a larger case series to date for this rare condition.