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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
During dissection of the first branchial cleft cyst, care must be taken to avoid damage to the adjacent facial nerve in cases where there is a tract leading up to or into the external auditory meatus (Figure 2.8). The deep or superficial lobes of the parotid gland may need to be mobilized or occasionally the superficial lobe may need to be resected if the tract extends deeply. A neurosurgical nerve stimulator is often helpful during the dissection. Tracts that extend toward the external auditory canal may require removal of the skin and cartilage components of it.
General Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rebecca Fish, Aisling Hogan, Aoife Lowery, Frank McDermott, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Yew-Wei Tan, Thomas Tsang
How would you treat a branchial cleft cyst?Make a careful surgical excision.The first cleft opens at the angle of the mandible and passes through branches of the facial nerve.The second cleft (most common) opens at the anterior border of sternocleidomastoid (SCM) between carotid bifurcation.The third cleft opens at the lower border of SCM and passes behind the carotid artery.
Congenital neck lumps
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
First branchial cleft abnormalities are rare, representing approximately 5% of branchial disorders. These fistulae and sinuses are embryonic duplication abnormalities of the first branchial cleft (type I) or of the first cleft and arch (type II), as classified by Work in 1972 [18]: Type I represents duplication of the membranous external ear canal and is of ectodermal origin. Type I fistulae typically open anterior and inferior to the tragus, communicating with an opening in the external ear canal or middle ear. The fistula tract is closely related to the parotid gland and lies superficial to the facial nerve.The commoner type II fistulae arise as duplication of the membranous ear canal and pinna, consisting of both ectodermal and mesodermal tissues. An anterior opening is located close to the angle of the mandible with a posterior opening in the lateral portion of the external ear canal or conchal bowl, without middle ear involvement. Type II fistulae may lie either medial or lateral to the facial nerve. This inconstant relationship means that repair of a type II fistula carries greater risk of causing injury to the facial nerve than expected for a type I fistula repair.
Prevalence of cystic metastases in a consecutive cohort of surgically removed branchial cleft cysts
Published in Acta Oto-Laryngologica, 2022
Lalle Hammarstedt Nordenvall, Evelina Jörtsö, Mathias von Beckerath, Edneia Tani, Sushma Nordemar, Rusana Bark
Branchial cleft cysts (BrCC) are congenital epithelial cysts. The majority of them (90%) arise on the lateral part of the neck from a failure of obliteration of the second branchial cleft [1]. They are the most common cystic lesion occurring in the neck and more than 75% present in the anterior triangle of the neck (regions IA, IB, IIA, III and IV) as a cystic swelling or lump. Regional metastasis from occult head- and neck squamous cell carcinoma (HNSCC), especially when occurring at region II to IV can mimic the BrCC as they both usually present as a swelling or lump in the neck [2,3]. Aside from HNSCC, papillary thyroid cancer (PTC) can also mimic a second branchial cleft cyst [4]. Several studies suggest a prevalence of enlarged HNSCC-metastases in 5–9.9% and lymph metastases of PTC in 1–4% of patients who underwent surgery because of suspected BrCC [5–8]. Age (>40 years) as well as the presence of enlarged lymph nodes seem to be a significant risk factor for malignancy instead of BrCC [6,7]. Because of the risk for cystic metastasis, patients over 40 years of age presenting with solitary cystic lesion are often subjected to extensive diagnostic work up before excision of the cyst.
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
The presentation of bilateral second branchial fistulae along with bilateral pre-auricular fistulae in a patient with no family history and no associated syndrome is very rare in clinical practice. Only 10 cases of bilateral branchial cleft fistulae were reported through reviews of the English literature to date [5,6,8–11]. Maddalozzo et al. [5] treated a total of 232 patients with branchial cleft anomalies and found that 90% of the cases were second branchial anomalies and only 12% were complete fistulae. Of these patients with second branchial fistulae, only three had bilateral fistulae. To our knowledge, this report is the largest study about second branchial cleft fistulae found in the medical literature. Recently, Kajosaari et al. [7] reviewed 255 cases of second branchial anomalies from six studies and found that 15% of the sinuses/fistulae were bilateral. We presented the clinical characteristics and surgical treatment of this case in hopes that it may be helpful to otorhinolaryngology doctors and to further studies about the exact mechanism of branchial anomalies.
A two-year-old with a duplicated external auditory canal; a first branchial cleft anomaly
Published in Acta Oto-Laryngologica Case Reports, 2019
Christianne C.A.F.M. Veugen, Henk M. Blom
First branchial cleft anomalies result from a subtotal closure of the ectodermal part of the first branchial cleft. They may present as a cysts, sinuses or fistulae, depending on the degree of closure [8,11]. They have been classified by Work in two groups based on histological and clinical features [9]. Type 1 anomalies are of ectodermal origin. Characteristically, these lesions occur medial to the concha. They lie superficial to the facial nerve and extend parallel to the normal external auditory canal. They terminate in a cul-de-sac near the osseous-cartilaginous intersection of the external auditory canal at the level of the mesotympanum. They usually present as a cyst; a sinus develops after rupture or secondary infection [8,9]. Type 2 anomalies are of ectodermal and mesodermal origin; containing both skin and cartilage. Characteristically, a sinus passes from an external opening cranial in the neck anterior to the sternocleidomastoid muscle, medial or lateral to the facial nerve and closely related to the parotid gland. The sinus ends either blindly or open in the cartilaginous external auditory canal [9,11]. In both types the middle ear cavity and the tympanic membrane are intact. Type 1 first branchial cleft anomalies are very rare, while Type 2 first branchial cleft anomalies are more frequent [12].