Sternoclavicular sinus: Case series and literature review of a rare head and neck lesion

Congenital Sternoclavicular Sinus-Case Series of a Rare Lower Neck Deformity

OBJECTIVES

We encountered patients with a congenital cutaneous sinus tract in the sternoclavicular joint region, which we designate as "congenital sternoclavicular sinus (CSCS)." The aim of this investigation is to enhance recognition of this subtle yet noteworthy entity and develop standardized protocols for its management.

PATIENTS AND METHODS

Between 2013 and 2023, 172 patients, including 78 males and 94 females, were referred to our institution for the management of CSCS. Clinical charts were retrospectively reviewed.

RESULTS

The majority of patients (60.5%) were young children below 3 years of age, with only six adult patients and a median age of 27.5 months. The left side was implicated in 157 cases (91.3%). In 146 cases (84.9%), a faint skin streak was noted above the orifice. Yet, no pharyngeal sinus tracts were detected, either through barium swallow studies or direct laryngoscopy. All skin lesions featured a diminutive orifice near the sternoclavicular joint, with the tract extending deeply into the subcutaneous tissue and terminating blindly, short of entering the joint, after a distance of 10 mm (ranging from 5 to 21 mm). Histopathological analysis revealed that the epithelial lining predominantly consisted of stratified squamous epithelium (87.8%), with ciliated columnar epithelium accounting for the remaining 12.2%.

CONCLUSIONS

CSCS, though infrequent, presents with distinctive pathological and clinical features. The condition predominantly affects the left sternoclavicular joint region, with the notable "skin streak sign" aiding in diagnosis. We considered CSCS as one disease entity of branchial arch anomalies. Complete surgical excision offers a definitive cure.

LEVEL OF EVIDENCE

4 Laryngoscope, 2024.

Congenital dermoid sinus of anterior chest: Case report and review of literature

INTRODUCTION

Congenital dermoid sinus which is a rare congenital anomaly of the anterior chest wall (CDACR) is frequently misdiagnosed or mistreated. This report aims to raise awareness about this condition and share experience based on a demarcation technique for anomalous tissue.

PRESENTATION OF CASE

A case of surgically treated CDACR in our clinic and subsequently confirmed through histopathology was chosen. Health records such as, demographics, visits, imaging modalities, management, outcome, and histopathology were reviewed of the patient.

DISCUSSION

Our patient aged 4 years underwent ultrasonography, which revealed a dermoid sinus on her right anterior chest. This diagnosis was later confirmed via histopathology after the excision of the sinus, which was facilitated by a mix of methylene blue and fibrin glue. The incision healed well without any complications.

CONCLUSION

Thus, it was found that CDACRs are those rare congenital anomalies requiring immediate excision to prevent recurrent infections or complications. Knowing how to identify and deal with them is essential.

The congenital sternoclavicular sinus: a single-institution retrospective study of 88 patients

BACKGROUND

Sinus near the sternoclavicular joint was considered as a rare congenital neck abnormality. Though it was reported as a dermoid sinus in some literatures, the embryological origin of the sinus was unclear. This study aimed at reviewing the clinical and histological characteristics and analyzing the possible embryological origin of this malformation in children.

METHODS

The medical records of all patients with congenital sternoclavicular sinus who underwent surgical resection between March 2018 through June 2020 were reviewed retrospectively. The clinical presentations, complications, histological examination, and treatment were analyzed.

RESULTS

Of the 88 patients with congenital sternoclavicular sinus included, the mean age of surgery was 2.73 ± 1.71 years old. The sinuses occurred on the left side in 73 (83.0%) cases. Sixty-three patients experienced sinus infection and 44 patients underwent incision and drainage before excision. All patients received surgical resection with one patient who recurred after surgery. Histopathological examination showed that the sinuses were lined by squamous epithelium in most patients. However, ciliated epithelium was observed in one patient and salivary glands were detected in two patients.

CONCLUSIONS

The congenital sternoclavicular sinus should be excised promptly to prevent recurrent infection. According to the ciliated epithelium and salivary gland were found in the wall of sinus, it should be viewed as the skin side remnant of the fourth branchial cleft rather than a dermoid cyst/sinus.

Congenital dermoid sinus of the anterior chest region

BACKGROUND

Congenital dermoid sinus of the anterior chest region (CDACR) is a rare developmental anomaly. Therefore, the aim of our study was to draw attention to this underrecognized lesion.

METHODS

From 2011 to 2019, our study group included 11 patients who presented to our hospital with pits and masses of their anterior chest walls. All lesions were surgically excised with histologic confirmation of the diagnosis of CDACR. The medical records of these patients were reviewed for the following data: patient age, gender, clinical characteristics of the lesion and site of involvement, department first visited, diagnostic evaluation, management, postoperative complications, and histopathological findings.

RESULTS

There was a clear left-sided predominance, with 10/11 cases occurring on the left and a female predominance of eight cases out of 11. Although the pits were present at birth, the mean age at presentation was 19.7 months. All patients showed clinical signs of infection at the time of presentation and were treated with antibiotics. Seven patients had a history of abscess formation treated with incision and drainage. Ultrasound was performed in eight patients. In all cases, the lesions, including pit and sinus, were completely excised.

CONCLUSIONS

Congenital dermoid sinus of the anterior chest region is likely underrecognized. We encountered a high frequency of complications such as infections or abscesses prior to surgical excision. Complete excision of CDACR is not technically difficult. Therefore, surgical removal should be considered, even for asymptomatic lesions, to avoid future complications and for cosmesis.