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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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Paul I, Mohiyuddin SMA, A S, Mohammadi K, Babu P. The Outcome of Treatment in Second Branchial Cleft Anomalies: A Case Series. Cureus 2023; 15:e40164. [PMID: 37431352 PMCID: PMC10329747 DOI: 10.7759/cureus.40164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 07/12/2023] Open
Abstract
Background Branchial-cleft anomalies are second only to thyroglossal duct anomalies among congenital malformations of the neck, and second branchial-cleft anomalies are the most common. These include branchial cysts, branchial sinuses, and branchial fistulas. Clinical symptoms include neck swelling and a discharging sinus or fistula opening. In a small number of cases, they can lead to major complications like abscesses or malignant changes. Surgical resection is the treatment of choice. Various approaches to resection and sclerotherapy have been tried. In this study, we present our treatment outcome with branchial cleft anomalies at a rural tertiary medical care hospital. Objectives To document the various presentations, clinical features, and outcomes of treatment with second branchial cleft anomalies. Methods This retrospective observational study included 16 patients operated on for second branchial-cleft anomalies. A detailed medical history was elicited, and an accurate clinical examination was done. A contrast-enhanced computed tomography (CECT) scan was done in all cases. A few cases required a fistulogram. The cysts, sinuses, or fistulas were resected en bloc by a single neck crease incision. Primary closure was done in all cases. A recurrence or pharyngocutaneous fistula required axial flap reconstruction. The complications and recurrences were documented. Result There were six children and 10 adults in our study. Seven cysts, five sinuses, and four fistulas were present, of which four were iatrogenic. In seven patients, imaging could not show the entire tract. There were four fistulas from the oropharynx to a cutaneous opening in the neck. A complete resection was done for all. Two pharyngocutaneous fistulas were treated with a pectoralis major myocutaneous (PMMC) flap. Three patients had wound dehiscence postoperatively. None of the patients had neurological or vascular injuries. Conclusion Second branchial cleft anomalies can be completely excised by a single neck crease incision. Meticulous surgery results in a low recurrence or complication rate. Following complete excision, in type IV anomalies, a purse-string suture at the pharyngeal opening ensures good closure and no recurrences.
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Affiliation(s)
- Indranil Paul
- Otorhinolaryngology & Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - S M Azeem Mohiyuddin
- Otorhinolaryngology & Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Sagayaraj A
- Otorhinolaryngology & Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Kouser Mohammadi
- Otorhinolaryngology & Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Prashanth Babu
- Otorhinolaryngology & Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
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Li LJ, Han ZF, Shang ST. Branchial cleft cyst arising in posterior mediastinum: A case report. Front Surg 2023; 9:1088142. [PMID: 36684371 PMCID: PMC9852708 DOI: 10.3389/fsurg.2022.1088142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/23/2022] [Indexed: 01/09/2023] Open
Abstract
Branchial cleft cysts are congenital diseases of the neck caused by abnormal embryonic development of the first to fourth branchial clefts. Most branchial cleft cysts are found in the head and neck, but branchial cleft cysts arising in posterior mediastinum are rarely reported. We report a 44-year-old Chinese man who was found to have a right-posterior mediastinal mass on chest computed tomography (CT) during a physical examination. The size of the mass was about 30.6 mm * 25.1 mm and enhanced CT of the chest showed an occupying lesion in the right parietal esophagus of the upper-posterior mediastinum with no significant enhancement. The patient was considered to have a neurogenic tumor with cystic change and underwent posterior mediastinal tumor resection. Postoperatively, pathological examination confirmed the final diagnosis of bronchial cleft cyst. The patient was discharged on the 7th day after surgery. One year postsurgery, no obvious recurrence was found in reexamination.
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Chen W, Zhou Y, Xu M, Xu R, Wang Q, Xu H, Chen J, Li X. Congenital second branchial cleft anomalies in children: A report of 52 surgical cases, with emphasis on characteristic CT findings. Front Pediatr 2023; 11:1088234. [PMID: 36937970 PMCID: PMC10020344 DOI: 10.3389/fped.2023.1088234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/14/2023] [Indexed: 03/06/2023] Open
Abstract
Objective The objectives of this study was to review the clinical features and surgical treatment outcomes of congenital second branchial cleft anomalies (CSBCAs) and to investigate the characteristic computed tomography (CT) findings of CSBCAs. Methods We conducted a retrospective study of 52 children who were referred to Shanghai Children's Hospital from October 2014 to December 2021 diagnosed as CSBCAs. Results There were 36 males and 16 females. Of them, 35 patients were presented as having a skin pit at birth or discharge from the skin opening on the lateral neck, and 17 patients presented with an asymptomatic or painful mass. The typical CT features of CSBCAs included isolated and homogeneously hypodense cystic lesions surrounded by a uniformly thin, smooth wall. CSBCAs were generally located at the anteromedial border of the sternocleidomastoid muscle, posterior to the submandibular gland, and lateral to the carotid sheath. All patients were treated surgically and only one case underwent ipsilateral tonsillectomy. After a median follow-up of 30 (range 4-90) months, no recurrence or complications were observed. Conclusions The CSBCAs show some characteristic CT findings, which can help clinicians diagnose and plan surgical strategies. High ligation of the lesions is sufficient for complete excision of CSBCAs.
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Affiliation(s)
- Wei Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yilong Zhou
- Department of Pediatric Otorhinolaryngology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Mengrou Xu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Rong Xu
- Department of Radiology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qingyu Wang
- Department of Pathology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hongming Xu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiarui Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyan Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Correspondence: Xiaoyan Li
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Durgut O, Gökgün ÖF, Gencay S. Evaluation of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio and Mean Platelet Volume in Patients with Branchial Cleft Cyst. Indian J Otolaryngol Head Neck Surg 2022; 74:5465-5468. [PMID: 36742740 PMCID: PMC9895673 DOI: 10.1007/s12070-021-02789-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/25/2021] [Indexed: 02/07/2023] Open
Abstract
Branchial cleft cysts are benign masses of the head and neck. Etiopathogenesis is unclear and many factors such as inflammatory mechanisms can play a role. The aim of our study is to investigate the predictive value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and mean platelet volume (MPV), which are hematologic inflammatory markers, in branchial cleft cyst (BCC). The records of 27 patients who were operated with the diagnosis of BCC in the ENT clinic between January 2011 and March 2020 and 27 healty subjects were retrospectively reviewed. The control group consisted age and sex-matched subjects scheduled for rhinoplasty. Neutrophil, lymphocyte, platelet and MPV values were recorded from the complete blood count samples for all participants. The statistical relationship for NLR, PLR and MPV values between the patient and the control groups was investigated. The NLR values of the patients were significantly lower than the healthy controls (p:0.007). But no statistically significant correlation was found for PLR (p:0.586) and MPV(p:0.676) values between the groups. This is the first study to evaluate the significance of NLR, PLR and MPV in branchial cleft cyst. Decreased NLR may be used as a predictive marker for BCC. But PLR ande MPV should not be used to predict branchial cleft cyst. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-021-02789-1.
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Affiliation(s)
- Osman Durgut
- Department of Otorhinolaryngology, Bursa Yuksek Ihtisas Training and Research Hospital, Health Science University, Mimarsinan Mahallesi, Emniyet Cd. No:35, 16310 Yıldırım, Bursa Turkey
| | - Ömer Faruk Gökgün
- Department of Otorhinolaryngology, Bursa Yuksek Ihtisas Training and Research Hospital, Health Science University, Mimarsinan Mahallesi, Emniyet Cd. No:35, 16310 Yıldırım, Bursa Turkey
| | - Sündüz Gencay
- Department of Otorhinolaryngology, Bursa Yuksek Ihtisas Training and Research Hospital, Health Science University, Mimarsinan Mahallesi, Emniyet Cd. No:35, 16310 Yıldırım, Bursa Turkey
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A Rare Case of a Large Ameloblastoma and Cervical Lynphoepitelial Cyst Treated Simultaneously by an Intraoral Approach and Immediate Reconstruction. J Craniofac Surg 2022; 34:e208-e212. [PMID: 35994740 DOI: 10.1097/scs.0000000000008928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/06/2022] [Indexed: 11/26/2022] Open
Abstract
Ameloblastoma is a benign locally aggressive odontogenic tumor of epithelial origin with unlimited growth capacity. Cervical lymphoepithelial cyst is a developmental cyst located in the superior-lateral region of the neck with treatment consisting of surgical excision, which presents low recurrence rates. This article reports the case of patient J.G.S.L., 24 years old, female, who reported to the service with a histopathological evaluation compatible with intraosseous mandibular ameloblastoma. On physical examination, a nontender swelling was palpable along the body of left mandible where the ameloblastoma was located, with a fluctuant region detected just below it. Imaging exams confirmed the suspicion of two independent lesions. The treatment plan consisted of two stages: first, mandibular resection of the area affected by the ameloblastoma, followed by reconstruction with a titanium plate simultaneous to excisional biopsy of the as yet undiagnosed lesion, both through intraoral access; second, mandibular reconstruction with iliac crest graft. Histopathological examination of the second lesion indicated a diagnosis of cervical lymphoepithelial cyst, being the first case in the literature with these concomitant lesions. Currently, the patient is in her third postoperative year with no signs of recurrence.
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7
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Alarfaj AA. Coexistence of thyroglossal duct cyst and second branchial cleft cyst in a young woman: A case report and literature review. Int J Surg Case Rep 2022; 95:107192. [PMID: 35598343 PMCID: PMC9127597 DOI: 10.1016/j.ijscr.2022.107192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/26/2022] [Accepted: 05/08/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Thyroglossal cysts represent 70% of congenital neck anomalies, and second branchial cleft anomalies are the most common anomalies (90%) of the branchial apparatus. However, their coexistence, especially in adults, is very rare. Presentation of case A 23-year-old woman presented with a 1-year history of lateral left neck swelling and midline swelling. Imaging and histopathological examination confirmed the diagnosis of a thyroglossal duct cyst and a second branchial cleft cyst. The Sistrunk procedure was performed for surgical excision of the masses. Discussion Only three cases of a coexisting thyroglossal duct cyst and branchial cleft have been reported. Conclusion When encountering patients, even adults, with neck lesions, clinicians must keep in mind the possibility of a coexistence of a thyroglossal duct and a branchial cleft cyst. Thyroglossal cysts represent 70% of congenital neck anomalies. Second branchial cleft anomalies are the most common branchial apparatus anomalies. Only three cases of coexisting thyroglossal duct and branchial cleft cysts have been reported. We present a rare case of a young woman with the two cysts coexisting.
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8
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Pupić-Bakrač J, Skitarelić N, Novaković J, Lasić V. Patho-Anatomic Spectrum of Branchial Cleft Anomalies: Proposal of Novel Classification System. J Oral Maxillofac Surg 2021; 80:341-348. [PMID: 34648755 DOI: 10.1016/j.joms.2021.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Histogenesis, nomenclature, and classification of branchial cleft anomalies (BCAs) have been subjects of controversy for decades. The purpose of this study was to investigate the accuracy of current developmental theories (congenital, lymph node, and hybrid branchial inclusion theories) in defining the anatomic and histopathological characteristics of BCAs. METHODS Ninety consecutive patients with BCAs who underwent surgical excision were enrolled in this 2-center retrospective cohort study. RESULTS The present study included 90 patients: 46 (51.11%) women and 44 (48.89%) men (P > .05). The mean age at presentation was 31.89±17.31 years. Altogether, 92 BCAs were identified within the study population including 49 (53.26%) on the left side and 43 (46.74%) on the right side (P > .05). The BCAs included 79 (85.87%) branchial cleft cysts, 11 (11.96%) branchial cleft sinuses, and 2 (2.17%) branchial cleft fistulae. Three (3.26%) BCAs were distributed in the head regions, 88 (95.65%) in the neck regions, and 1 (1.09%) in the thoracic cavity. Following surgery, lymphoepithelial tissue was detected in the histopathological examination in 83 (90.22%) BCAs. The hybrid branchial inclusion theory exhibited significantly higher accuracy in defining patho-anatomic characteristics of BCAs than the branchial apparatus, precervical sinus, thymopharyngeal, and inclusion theories (90.22, 9.78, 2.17, 0.00, and 0.00%; respectively) (P < .05). CONCLUSION The novel branchial node (BN) classification system based on the hybrid branchial inclusion theory appears to be superior to other classification systems in determining the patho-anatomy of BCAs.
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Affiliation(s)
- Jure Pupić-Bakrač
- Resident, Department of Otorhinolaryngology and Maxillofacial Surgery, General Hospital Zadar, Zadar, Croatia
| | - Neven Skitarelić
- Resident, Department of Otorhinolaryngology and Maxillofacial Surgery, General Hospital Zadar, Zadar, Croatia; Professor, Department of Health Studies, University of Zadar, Zadar, Croatia; Professor, Faculty of Medicine, University of Rijeka, Rijeka, Croatia; Department Head, Department of Otorhinolaryngology and Maxillofacial Surgery, General Hospital Zadar, Zadar, Croatia.
| | - Josip Novaković
- Physician Associate, Department of Otorhinolaryngology and Maxillofacial Surgery, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Valentina Lasić
- Resident, Department of Pediatric Surgery, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
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9
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Xian Z, Chen Y, Teng Y, Han S, Li L. Second branchial cleft cyst with snoring during sleep as initial symptom: A case report and literature review. Medicine (Baltimore) 2021; 100:e27037. [PMID: 34449485 PMCID: PMC8389974 DOI: 10.1097/md.0000000000027037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/10/2021] [Indexed: 01/04/2023] Open
Abstract
The second branchial cleft cyst lacks typical symptoms, and its clinical manifestations are complex and varied. Among them, the second branchial cleft cyst manifested by sleep snoring is relatively rare, and it can easily lead to missed diagnosis or misdiagnosis. This paper reports a case of a second branchial cleft abscess with snoring as the main manifestation. The branchial cleft cyst was removed using an endoscopic branchial cleft.
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10
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Meijers S, Meijers R, van der Veen E, van den Aardweg M, Bruijnzeel H. A Systematic Literature Review to Compare Clinical Outcomes of Different Surgical Techniques for Second Branchial Cyst Removal. Ann Otol Rhinol Laryngol 2021; 131:435-444. [PMID: 34137276 PMCID: PMC8899809 DOI: 10.1177/00034894211024049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objective: During the last 2 decades, new treatment methods have been developed for the
surgical removal of second branchial cysts which result in less visible
scars. The aim of this systematic review is to assess which surgical
technique for second branchial arch cyst removal results in the lowest
complication and recurrence rates with the highest scar satisfaction. Methods: Two authors systematically reviewed the literature in the Cochrane, PubMed,
and EMBASE databases (search date: 1975 to December 2nd, 2020) to identify
studies comparing surgical outcomes of second branchial arch cyst removal.
Authors appraised selected studies on directness of evidence and risk of
bias. Results are reported according to Preferred Reporting Items for
Systematic Reviews and Meta-Analyses statement. Results: Out of the 2442 retrieved articles, 4 articles were included in the current
review including a total of 140 operated cysts. Only 2 studies included
pre-operatively infected cysts. Follow up ranged from 3 to 24 months.
Complication rates ranged from 0 to 27.3% (conventional: [0–10.4%];
endoscopic/retro-auricular: [0–27.3%]). None of the patients presented with
postoperative recurrence. Significantly higher scar satisfaction was found
in adult patients who underwent endoscopic or retro-auricular hairline
incision cyst removal. Conclusion: No recurrence of disease occurred during (at least) 3 months of follow up
using either conventional surgery or endoscopic/retro-auricular techniques.
Although more (temporary) complications occur using endoscopic and
retro-auricular techniques, patients report a significantly higher scar
satisfaction 3 to 6 months after surgery in comparison to the conventional
technique. Future studies are needed to support these findings.
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Affiliation(s)
- Sebastiaan Meijers
- Department of Otorhinolaryngology and
Head and Neck Surgery, University Medical Center Utrecht, the Netherlands
| | - Rutger Meijers
- Department of Neurology, Radboud
University Medical Center, Nijmegen, The Netherlands
| | - Erwin van der Veen
- Department of Otorhinolaryngology and
Head and Neck Surgery, University Medical Center Utrecht, the Netherlands
- Central Military Hospital, Utrecht, The
Netherlands
| | - Maaike van den Aardweg
- Department of Otorhinolaryngology and
Head and Neck Surgery, Rivierenland Hospital, Tiel, The Netherlands
| | - Hanneke Bruijnzeel
- Department of Otorhinolaryngology and
Head and Neck Surgery, University Medical Center Utrecht, the Netherlands
- Brain Center Rudolf Magnus, Utrecht,
The Netherlands
- Hanneke Bruijnzeel, MD, PhD, Department of
Otolaryngology and Head and Neck Surgery, Utrecht Medical Center, Heidelberglaan
100, Utrecht 3584 CX, The Netherlands.
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11
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Clinical and ultrasound characteristics of pediatric lateral neck masses. PLoS One 2021; 16:e0251563. [PMID: 33979396 PMCID: PMC8115835 DOI: 10.1371/journal.pone.0251563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 04/27/2021] [Indexed: 11/19/2022] Open
Abstract
Lateral neck masses (LNM) often present a diagnostic challenge in the practice of pediatric plastic surgeon. The aim of this study is to investigate the clinical and ultrasound (US) characteristics of pediatric LNM in order to make mutual comparison between their entities and enable the most accurate preoperative diagnosis. A cross-sectional study was conducted among 250 pediatric patients treated by surgical excision or sclerotherapy in our institution in the period from July 2009 to June 2019. Lymphatic malformation was the most frequent congenital LNM (60.9%), while reactive or granulomatous lymphadenitis was the most frequent acquired LNM (47%). Congenital anomalies were significantly more often localized in the upper half of the sternocleidomastoid (SCM) muscle region, and had more often soft consistency than acquired ones. Congenital LNM had a 32.37 (3.44–304.63) times higher likelihood of incorrect (p = 0.002) and 5.86 (1.35–25.48) times higher likelihood of undetermined (p = 0.018) than correct US findings, respectively. Acquired LNM were significantly more often localized in the region behind the SCM muscle and more often had solid US appearance in comparison to the congenital ones. Association of the clinical and US findings is very important in determining the most accurate preoperative diagnosis without exposing the children to unnecessary utilizing ionizing radiation or anesthesia. Although they are mostly benign, extreme caution is necessary due to malignancies which were found in 16.4% of all our patients.
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12
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Wojtas E, Mendez A, Donald C, Hinni M. Presentation of a branchial cleft anomaly in an adult. JAAPA 2021; 34:1-5. [PMID: 33906213 DOI: 10.1097/01.jaa.0000733232.89635.fe] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Branchial cleft anomalies are the second most common type of congenital neck mass and typically are diagnosed in patients under age 5 years. This article describes a rare presentation of an adult with a branchial cleft anomaly.
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Affiliation(s)
- Emily Wojtas
- Emily Wojtas, Anthony Mendez , and Carrlene Donald practice in the Mayo Clinic Phoenix (Ariz.) Hospital's Otorhinolaryngology Head and Neck Surgery Department. Michael Hinni is chair of the Otolaryngology Head and Neck Surgery department at Mayo Clinic Phoenix Hospital
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Xing MH, Mundi N, Govindan A, Khorsandi A, Urken ML. Unusual location of a second branchial cleft cyst presenting in the suprasternal notch. Head Neck 2021; 43:E27-E29. [PMID: 33533131 DOI: 10.1002/hed.26629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/26/2020] [Accepted: 01/21/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Second branchial cleft cysts (SBCCs) are congenital benign tumors that comprise up to 90% of all branchial cleft anomalies. SBCCs typically present in the lateral neck along the anterior border of the upper third of the sternocleidomastoid muscle. We describe a case of a SBCC presenting in an unusual location in the lower neck close to midline. METHODS An 18-year-old male presented with a 2-year history of a neck mass in the suprasternal notch. Imaging findings were reviewed with a head and neck radiologist who felt that the findings were highly suggestive of a fourth branchial cleft cyst. RESULTS The patient underwent surgical excision of the mass. Final pathologic evaluation confirmed the diagnosis of a second branchial cleft cyst. CONCLUSIONS Though extremely uncommon, second branchial cleft cysts can extend to the suprasternal notch and should not be excluded from the differential diagnoses of lower neck masses.
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Affiliation(s)
- Monica H Xing
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - Neil Mundi
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New York, New York, USA
| | - Aparna Govindan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New York, New York, USA
| | - Azita Khorsandi
- Department of Radiology, New York Eye and Ear Infirmary, Mount Sinai Health System, New York, New York, USA
| | - Mark L Urken
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New York, New York, USA
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Branchial cleft anomalies: hybrid "Branchial Inclusion" theory. Eur Arch Otorhinolaryngol 2021; 278:2593-2601. [PMID: 33427915 DOI: 10.1007/s00405-020-06551-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/04/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Branchial cleft anomalies (BCAs) are developmental malformations of the head and neck region. Their histogenesis has been the subject of controversy and is not fully understood. This study aimed to test all present developmental theories ("branchial apparatus," "precervical sinus," "thymopharyngeal," and "inclusion" theories) on a sample of 48 BCAs from a single institution. METHODS We performed a retrospective analysis of clinical-epidemiological and anatomical-pathological characteristics of BCAs treated over a 12-year period in our hospital. RESULTS Overall, 46 patients (24 [52.17%] women and 22 men [47.83%]) underwent surgical excision of 48 BCAs. The mean patient age at presentation was 31.65 ± 19.40 years. Branchial cleft cysts were found in 42 (87.50%) cases, and branchial cleft sinuses were found in six (12.50%) cases. Eight (16.67%) BCAs were distributed in the preauricular region, 34 (70.83%) at the anterior border of the sternocleidomastoid muscle (SCM), three (6.25%) at the posterior border of the SCM, two (4.17%) in the suprasternal notch, and one (2.08%) in the retrosternal space. Histopathologically, 39 (81.25%) BCAs had a lymphoepithelial structure and nine (18.75%) BCAs had solitary epithelial cells. Inflammation and infection were observed in 24 (50%) and 12 (25%) cases, respectively. CONCLUSION None of the hypothesized developmental theories fully explain the embryonic origin of BCA in our study sample. A possible explanation of BCA histogenesis is through the hybrid "branchial inclusion" theory.
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Abstract
Congenital neck masses (CNMs) are developmental malformations that present with a wide spectrum of clinical symptoms and signs. They account for 21% to 45% of neck masses in children and 5% to 14% in adults. This study aimed to present the clinical manifestations and treatment of CNM from single-institution experiences. A retrospective analysis of patients surgically treated for CNM in a 12-year period was performed. Altogether, 117 patients (female/male ratio, 1:1.05) were diagnosed with CNM. The mean age at presentation was 26.91 years (range, 0.01-84 years). Within the study population, 120 CNMs were identified: 52 (43.33%) thyroglossal duct remnants, 48 (40.00%) branchial cleft anomalies, 7 (5.83%) epidermoid/dermoid cysts, 4 (3.33%) hemangiomas, 3 (2.50%) lymphangiomas, 1 (0.83%) hemangiolymphangioma, 1 (0.83%) hemangioendothelioma, 1 (0.83%) internal laryngocele, 1 (0.83%) external laryngocele, 1 (0.83%) ectopic thyroid gland, and 1 (0.83%) parathyroid cyst. The lateral neck region was the most frequently affected anatomical site, followed by the midline neck location and mediastinum (54%, 45%, and 1%, respectively). Surgical excision was performed in all cases. Recurrence was recorded in 5 (4.17%) patients. The results of this study provide comprehensive information regarding the clinical spectrum of CNM. Successful management of these lesions depends on a thorough understanding of neck embryology and anatomy. Misdiagnosis and improper treatment increase the morbidity and recurrence rate of CNM.
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