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Pupić-Bakrač J, Jayasekara S, Peiris PM, Jayasinghe LAH, Kapugama K, Jayasuriya NSS, Wijekoon P, Attygalla M. Malignancy and "Violated Neck" Rates in Consecutive Cohort of 79 Adult Patients With Solitary Cystic Neck Mass-Lessons Learned and Recommendations for Clinical Practice Guidelines. J Craniofac Surg 2024; 35:e380-e385. [PMID: 38651860 DOI: 10.1097/scs.0000000000010122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/12/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE The neck region is a common site for solitary cystic neck mass (SCNM) of various etiologies, including congenital, inflammatory, and neoplastic. In adults, the primary focus is excluding malignancy. The objective of this study was to retrospectively analyze the accuracy of available diagnostic technologies for the differentiation of benign and malignant SCNM in adult patients. The study aimed to develop new clinical practice guidelines for evaluating and managing SCNM. METHODS The primary predictive variables were the diagnostic utilities of fine-needle aspiration cytology (FNAC), ultrasound (U/S), multislice computed tomography, and magnetic resonance imaging. The study's endpoint was the overall diagnostic accuracy in differentiating between benign and malignant SCNM. The final diagnosis was based on histopathology. RESULTS The study included 79 adult patients: 55 (69.62%) male and 24 (30.38%) female ( P <0.05). The mean age at presentation was 42.1 years (range: 18-84 years). Solitary cystic neck mass was distributed in the anterior neck region in 30 (37.97%) patients and the posterolateral neck regions in 49 (62.03%) patients ( P <0.05). The posterolateral neck regions had a significantly higher rate of malignant SCNM than the anterior neck region [19/49 (38.78%) versus 1/30 (3.33%)] ( P <0.05). There was no statistically significant difference between the U/S+FNAC and U/S+FNAC+multislice computed tomography and/or magnetic resonance imaging groups in differentiating benign and malignant SCNM (40/42 versus 36/37, P >0.05). "Violated neck" was recorded in 2 cases. CONCLUSION A systematic investigation protocol should be applied to evaluate adult patients with SCNM.
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Affiliation(s)
- Jure Pupić-Bakrač
- Department of Otorhinolaryngology and Maxillofacial Surgery, General Hospital Zadar, Zadar, Croatia
| | - Sandeep Jayasekara
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Prasangi M Peiris
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Kanchana Kapugama
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Nadeena S S Jayasuriya
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Parakrama Wijekoon
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Manjula Attygalla
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
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Wang FJ, Xu F, Xiao LH, Qin F, Zhang LH, Wang L, Qi XQ, Weng CY. Ultrasound diagnosis and treatment of branchial cleft cyst and preoperative management. Eur Arch Otorhinolaryngol 2024; 281:419-425. [PMID: 37673830 DOI: 10.1007/s00405-023-08209-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE The ultrasonic diagnosis of cervical and facial cystic masses, as well as cases of missed diagnosis and misdiagnosis, was examined, to improve the diagnosis of branchial cleft anomalies. METHODS A retrospective analysis was conducted on 17 patients with branchial cleft cyst anomalies, including 11 males and 6 females, aged 12-53 years, with an average age of 33 ± 2 years, were unilateral single. All patients who underwent an ultrasound examination and image storage for retrospective analysis, and both longitudinal and transverse sections were scanned to observe the shape, size, boundary, peripheral relationship, and blood flow signal of the masses. All cases were examined with an enhanced CT scan, and pathological reports were generated. RESULTS Among the 17 cases of branchial cleft anomalies, 15 cases were branchial cleft cysts, while one case involved fistula formation and one case involved sinus tract formation. Based on the type of branchial cleft, the first, second, and third cysts were classified in 4, 12, and 1 case, respectively. The sensitivity rate and specificity of ultrasonic diagnosis were 14/17 (82.4%) and 4/6 (66.7%), respectively. Ultrasonic characteristic analysis for the masses can be found in simple cystic masses or hypoechoic masses, most of them are of a regular shape and have a distinct boundary, and almost no blood flow signal. All patients who were misdiagnosed exhibited blood flow signals, including 1 patient with an abundant blood flow signal, 1 patient suspected of having ectopic thyroid with an abnormal function due to the rat-tail sign, 2 patients misdiagnosed as local inflammatory focus, and 1 patient misdiagnosed with tuberculous lymphadenitis. CONCLUSION Ultrasound has a detection rate of up to 100% for cervical and facial masses, providing a fundamental determination of lesion characteristics and specific guidance for preoperative diagnosis. If the blood flow signals can be identified and carefully considered their peripheral relationship, the diagnostic rate can be improved.
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Affiliation(s)
- Fu-Jian Wang
- Department of Ultrasound, The Ninth People's Hospital of Hangzhou, No. 98 of Yi-Rong Road, Yi-PengStreet, QianTANG District, Hangzhou, 311225, Zhejiang, China
| | - Fang Xu
- Department of Ultrasound, The Ninth People's Hospital of Hangzhou, No. 98 of Yi-Rong Road, Yi-PengStreet, QianTANG District, Hangzhou, 311225, Zhejiang, China
| | - Li-Hua Xiao
- Department of Ultrasound, The Ninth People's Hospital of Hangzhou, No. 98 of Yi-Rong Road, Yi-PengStreet, QianTANG District, Hangzhou, 311225, Zhejiang, China
| | - Feng Qin
- Department of Ultrasound, The Ninth People's Hospital of Hangzhou, No. 98 of Yi-Rong Road, Yi-PengStreet, QianTANG District, Hangzhou, 311225, Zhejiang, China
| | - Li-Hong Zhang
- Department of Ultrasound, The Ninth People's Hospital of Hangzhou, No. 98 of Yi-Rong Road, Yi-PengStreet, QianTANG District, Hangzhou, 311225, Zhejiang, China
| | - Li Wang
- Department of Ultrasound, The Ninth People's Hospital of Hangzhou, No. 98 of Yi-Rong Road, Yi-PengStreet, QianTANG District, Hangzhou, 311225, Zhejiang, China
| | - Xiao-Qing Qi
- Department of Ultrasound, The Ninth People's Hospital of Hangzhou, No. 98 of Yi-Rong Road, Yi-PengStreet, QianTANG District, Hangzhou, 311225, Zhejiang, China.
| | - Chao-Yang Weng
- Department of Ultrasound, The Ninth People's Hospital of Hangzhou, No. 98 of Yi-Rong Road, Yi-PengStreet, QianTANG District, Hangzhou, 311225, Zhejiang, China.
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Wang HC, Yuan HW, Zeng CQ, Teng YS. Treatment of Work Type II Congenital First Branchial Cleft Anomalies: A Summary of 35 Cases. EAR, NOSE & THROAT JOURNAL 2023:1455613231218136. [PMID: 38084860 DOI: 10.1177/01455613231218136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
Objective: This study aims to summarize the data and treatment of 35 children with Work type II congenital first branchial cleft anomalies (CFBCAs) to provide significant insights into the correlation between these anomalies and the facial nerve. Methods: A total of 35 children diagnosed with Work type II CFBCAs who received treatment at the Department of Otolaryngology-Head and Neck Surgery at Shenzhen Children's Hospital from August 2017 to March 2023 were analyzed retrospectively. Pearson chi-square tests and Fisher's exact tests were used to examine the relationship between clinical characteristics and the location of the lesion, which included the superficial and deep surfaces as well as the area between the branches of the facial nerve. Results: All 35 children underwent open incision and complete resection of fistulae. During the surgery, the lesions were found to be in the superficial facial nerve in 12 (34.3%) cases, between branches in 5 (14.3%) cases, and in the deep facial nerve in 18 (51.4%) cases. In those patients, lesions in females, with a lower edge of the lesion located below the angle of the mandible and the presence of a tympanic membranous attachment, are more likely to be located deep to the facial nerve or between its branches. The difference is statistically significant (P = .007, .032, .015). Conclusion: The treatment principle of Work type II CFBCAs consists of achieving a quiescent stage of inflammation, followed by a complete resection of the lesion on the premise of preserving facial nerve function. Certain clinical features of this disease can predict the relationship between the lesion and the facial nerve. The lesions in females, with a lower edge of the lesion located below the angle of the mandible, non-cystic type of Olsen, and the presence of tympanic membranous attachment, tend to be located deep to the facial nerve or between its branches.
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Affiliation(s)
- Hao-Cheng Wang
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, China Medical University, Shenzhen, Guangdong, China
| | - Hu-Wei Yuan
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Chun-Qin Zeng
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, China Medical University, Shenzhen, Guangdong, China
| | - Yi-Shu Teng
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
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Booth TN. Congenital Cystic Neck Masses. Neuroimaging Clin N Am 2023; 33:591-605. [PMID: 37741660 DOI: 10.1016/j.nic.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
Congenital cystic masses are commonly encountered when imaging a patient presenting with a neck mass. Congenital cysts are present at birth; however, these cysts may not present until later in life with some growing slowly and others rapidly increasing in size due to hemorrhage of infection. A neonatal presentation is rare but when present may allow a narrower differential diagnosis. Imaging plays a significant role in defining a lesion as cystic, assessing location, and directing the next step in evaluation and or intervention.
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Affiliation(s)
- Timothy N Booth
- University of Texas Southwestern, Children's Health of Texas, 1935 Medical District Drive, Dallas, TX 75235, USA.
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Abstract
Congenital anomalies of the external auditory canal (EAC) are classically divided into congenital aural atresia (CAA) and congenital aural stenosis (CAS). CAA can present as an isolated anomaly, unilateral or bilateral, or in the setting of a craniofacial syndrome. Hearing testing (ABR with air and bone conduction thresholds for both ears) early in the perinatal period is important to document hearing thresholds. Hearing status thus informs parent counseling on options for hearing habilitation: Bone conducting technology is a must for children with bilateral CAA to support normal speech and language development. Bone conducting technology should be considered for children with unilateral CAA; benefits are unclear. In select candidates, atresia repair can provide improved hearing with a clean, dry, epithelialized ear canal. First branchial cleft cyst or sinus is rare; high index of suspicion is needed to diagnose along with high-resolution CT. Congenital aural stenosis (CAS) is a rare condition, and hearing testing should be similar to that in children with CAA. Early (age 4-5) CT imaging is recommended in the setting of a canal <2 mm or pinpoint canal to evaluate for trapped skin/ear canal cholesteatoma.
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Affiliation(s)
- Daniel Morrison
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia School of Medicine, University of Virginia Department of Otolaryngology, Box 800713, Charlottesville, VA, USA
| | - Bradley Kesser
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia School of Medicine, University of Virginia Department of Otolaryngology, Box 800713, Charlottesville, VA, USA.
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