Congenital postauricular swelling in a child

A fatal case of severe neck abscess due to a third branchial cleft fistula: morphologic and immunohistochemical analyses

Background

Branchial cleft anomalies constitute a frequently encountered and commonly non-lethal disease in otolaryngology, and result from aberrant embryonic development. The third branchial cleft fistula is one of the four known specific types of branchial cleft anomalies, and always presents as recurrent neck abscess and suppurative thyroiditis. Here, we report an unexpected death due to severe neck infection following a third branchial cleft fistula.

Case presentation

A 19-year-old man was sent to the hospital with a 1-week history of recurrent left-sided neck abscess, and was scheduled for incision and drainage of the abscess. However, before the surgery was performed, the man’s condition deteriorated and he died. A review of his medical history showed that he had undergone a previous incision and drainage for a neck abscess 2 years ago. Postmortem examination revealed that the fatal neck abscess was induced by a third branchial cleft fistula.

Conclusions

We conclude that a histopathological examination of neck tissue combined with a detailed review of medical history and examination of ultrasonographic and CT images can provide a rapid and accurate diagnosis of third branchial cleft fistula. This common, non-lethal disease can potentially lead to death if the neck infection is not properly diagnosed and treated. In medico-legal practice, medical examiners should be aware of this condition, as this knowledge would be important in the diagnosis of the cause of death.

First branchial cleft fistula presenting with internal opening on the Eustachian tube: Illustrated cases and literature review

OBJECTIVE

Two cases of first branchial cleft fistula with internal opening on the Eustachian tube are reported and the diagnosis, management and embryological hypothesis are discussed.

DESIGN

Retrospective study and review of the literature.

RESULTS

Both patients were young boys with first branchial cleft anomaly clearly identified by computed tomography fistulography scan and direct Methylene Blue dye injection. In both cases, surgical removal revealed a fistula with internal opening located on the Eustachian tube near the nasopharynx.

DISCUSSION

The main embryological theories and classification are reviewed. A connection between the theories of first branchial apparatus development and the classification by Work might explain the reported clinical association.

A misdiagnosis: duplication of the external auditory canal

We present imaging and clinical findings of a case with a duplicated external auditory canal, which led to misdiagnosis secondary to lipomatous content on imaging studies prior to surgery. It is a very rare congenital anomaly. This entity is usually misdiagnosed not only clinically but also radiologically. This leads to a delay and failure in diagnosis and treatment. To the best of our knowledge, herein is the first case report of the duplication of the external auditory canal presenting with dominant lipomatous imaging features. In this report, we aim to draw attention to the atypical presentation.

Dermal cysts: a dermatopathological perspective and histological reappraisal

Dermal cysts constitute an extremely common entity routinely encountered in dermatology and dermatopathology practice. Their ubiquity, overlapping clinical presentation, dermal location, and histologic diversity can engender diagnostic quandary. Though basically defined by the histologic presence of an epithelial lining, cysts derive from a variety of sources including developmental defects, trauma, and tumoral degeneration. Herein, we will discuss the dermatopathologic attributes of the more common dermal cyst entities, updating the most recent and pertinent literature.

Unusual extension of the first branchial cleft anomaly

First branchial cleft is the only branchial structure that persists as the external ear canal, while all other clefts are resorbed. Incomplete obliteration and the degree of closure cause the varied types of first branchial cleft anomalies. They were classified based on the anatomical and histological features. We present an unusual type of first branchial cleft anomaly involving the external auditory canal, the middle ear and the nasopharynx through the eustachian tube.

Malformations of the first branchial cleft: duplication of the external auditory canal

OBJECTIVE

Malformations of the first branchial cleft are uncommon and only sporadic reported in the literature. The may be present as a swelling or inflammatory opening on the neck, blind cysts or fistula associated with the external auditory canal. In this retrospective study, clinical features, diagnostic and therapeutic pitfalls are described in nine pediatric cases.

PATIENTS AND RESULTS

Between 1998 and 2002, duplication of the external auditory canal were diagnosed in nine patients aged from 7 months to 14 years. Three infants had cysts in the external ear canal; one had a sinus on the anteroinferior canal wall. One girl had two canals divided by skin and both were blind ended. Three children had clinically swelling or abscess formation with persistent drainage below the earlobe or on the neck and one girl had swelling behind the auricle. All patients were treated surgically.

CONCLUSION

The first branchial cleft malformation may be unrecognized or may be mistaken for tumors or other inflammatory lesions in the periauricular region. Surgical treatment might then be inadequate leading to recurrence or secondary infection. The distinct clinical features, which can be derived from embryologic development, usually lead to the correct diagnosis and favorable surgical treatment.