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Magalhães R, Louro M, Forny D, Sá Á, Franco D. Congenital midline cervical cleft: Management of a case series and literature review. J Plast Reconstr Aesthet Surg 2024; 93:117-126. [PMID: 38688177 DOI: 10.1016/j.bjps.2024.04.010] [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: 06/12/2023] [Revised: 02/02/2024] [Accepted: 04/05/2024] [Indexed: 05/02/2024]
Abstract
Congenital midline cervical cleft is a rare anomaly classified as a malformation of the branchial arches and represents less than 2% of congenital cervical malformations. Its clinical presentation involves cervical midline deformities: cephalic nodular lesion, linear groove with atrophic surface, and/or caudal sinus. Other midline alterations of variable complexity may also be present. Early treatment allows for avoiding long-term complications. Based on our experience in four clinical cases, a performed literature search on the topic in the last twenty years, and subsequent discussion of the employed surgical approaches, we included 150 reported cases in our review. Correct diagnosis and early treatment with complete removal of the fibrous midline band is paramount to avoid patient complaints until adolescence or adulthood.
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Affiliation(s)
- Raquel Magalhães
- Plastic Surgeon of Brazilian Society of Plastic Surgery, Brazil.
| | - Marcos Louro
- Plastic Surgery Residency Program, Clementino Fraga Filho University Hospital (HUCFF), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Danielle Forny
- Department of Pediatric Surgery, Martagão Gesteira Pediatric Institute (IPPMG), Federal UFRJ, Brazil
| | - Álvaro Sá
- Plastic Surgeon of Brazilian Society of Plastic Surgery, Brazil
| | - Diogo Franco
- Department of Surgery - Plastic Surgery Section, Clementino Fraga Filho University Hospital (HUCFF), Federal UFRJ, Rio de Janeiro, Brazil
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2
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Tonello C, de Matos ICP, Feitosa LB, Peixoto AP, Alonso N. Congenital Midline Cervical Cleft: A Variant of Tessier Number 30 Cleft Causing Micrognathia. Cleft Palate Craniofac J 2021; 58:1446-1451. [PMID: 33438460 DOI: 10.1177/1055665620987412] [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: 11/16/2022] Open
Abstract
Congenital midline cervical cleft is a rare and generally isolated malformation of the ventral neck region with no clear etiology established. Mandibular deformities, such as micrognathia, could be considered as a consequence of a cleft cervical contracture. Complete surgical excision of the subcutaneous fibrous cord at an early age is the primary treatment modality, minimizing growth development problems on surrounding affected tissue. The aim of this study is to describe the clinical, surgical, and histological findings in a female child with congenital midline cervical cleft along with a relevant literature review. Three years follow-up after surgery exhibited satisfactory functional and cosmetic results.
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Affiliation(s)
- Cristiano Tonello
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Brazil
| | | | | | - Adriano Porto Peixoto
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Brazil
| | - Nivaldo Alonso
- Hospital for Rehabilitation of Craniofacial Anomalies and Hospital of Clinics of Medicine Faculty, University of São Paulo, Brazil
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Zarbo A, Luk KM, Shwayder TA, Friedman BJ. Congenital midline nodules on the chin and sternum. Pediatr Dermatol 2020; 37:1145-1146. [PMID: 33283934 DOI: 10.1111/pde.14261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Allison Zarbo
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA.,Division of Pediatric Dermatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Kevin M Luk
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Tor A Shwayder
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA.,Division of Pediatric Dermatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Ben J Friedman
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA.,Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan, USA
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Riba M, Bejarano M, Hernández C, Moraleda I, Massaguer C, Ribalta T, Gómez M, Krauel L, Parri FJ, Albert A. Midline Cervical Cleft: An Anatomical Finding and a Proposal for a New Approach. Cleft Palate Craniofac J 2020; 57:1422-1427. [PMID: 32806933 DOI: 10.1177/1055665620947957] [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] [Indexed: 11/16/2022] Open
Abstract
Congenital midline cervical cleft is a rare malformation. Typical case shows an area of hypotrophic skin, a cranial nipple-like structure, and a caudal blind sinus. Cervical extension is limited. Relapse of the retraction is common following cutaneous z-plasty. The aim of this study is to describe the radiological, surgical, and histological findings of the 4 cases treated in our center in the last 8 years and communicate the finding of a contractile structure, anterior to the platysma, composed by striated muscle, figure not previously described. This distinct muscular band is responsible for neck retraction. Removal of this releases cervical tension and is essential to avoid the relapse.
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Affiliation(s)
- Mireia Riba
- Department of Pediatric Surgery, 16512Hospital Sant Joan de Déu, University of Barcelona, Spain
| | - Miguel Bejarano
- Department of Pediatric Surgery, 16512Hospital Sant Joan de Déu, University of Barcelona, Spain
| | - Carlos Hernández
- Department of Pediatric Surgery, 16512Hospital Sant Joan de Déu, University of Barcelona, Spain.,Department of Pediatric Surgery, 156300Hospital Universitario de Burgos, Spain
| | - Inés Moraleda
- Department of Pediatric Surgery, 16512Hospital Sant Joan de Déu, University of Barcelona, Spain
| | - Clara Massaguer
- Department of Pediatric Surgery, 16512Hospital Sant Joan de Déu, University of Barcelona, Spain
| | - Teresa Ribalta
- Department of Pathological Anatomy, 16512Hospital Sant Joan de Déu, University of Barcelona, Spain
| | - Marta Gómez
- Department of Radiology, 16512Hospital Sant Joan de Déu, University of Barcelona, Spain
| | - Lucas Krauel
- Department of Pediatric Surgery, 16512Hospital Sant Joan de Déu, University of Barcelona, Spain
| | - Francisco J Parri
- Department of Pediatric Surgery, 16512Hospital Sant Joan de Déu, University of Barcelona, Spain
| | - Asteria Albert
- Department of Pediatric Surgery, 16512Hospital Sant Joan de Déu, University of Barcelona, Spain
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D'Souza JN, Valika T, Maddalozzo J. Surgical management of midline cervical cleft. Int J Pediatr Otorhinolaryngol 2019; 127:109657. [PMID: 31491734 DOI: 10.1016/j.ijporl.2019.109657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Midline Cervical Cleft (MCC) is a midline cervical congenital anomaly that manifests as a vertical cutaneous/subcutaneous defect with abnormal dermal elements as well as an underlying fibrous cord that extends from the sternum to the mentum of the mandible, which can lead to "wry neck" and hypoplastic mandible. The goal of surgical correction of MCC is to provide adequate healthy tissue coverage, as well as restore contour of the anterior neck. The primary treatment modality for midline cervical cleft is surgical. We describe a technique involving complete excision of the fibrous cord, and use of double z-plasty flap in order to create a tension-free closure and restore contour to the anterior neck. METHODS Using a database search method, children with the clinical diagnosis of midline cervical cleft treated between 2006 and 2016 were identified at a pediatric tertiary care center. Chart review was completed to assess for age at surgery, follow up, results, and complications. RESULTS 12 patients were identified in the Lurie Children's Hospital (LCH) database. 8 patients underwent complete cord excision by the seniorauthor using the double z-plasty (DZ) technique for closure, with no recurrences. 4 patients underwent linear closure by another surgeon, had persistent contracture, and underwent revision using the DZ technique by the senior author, with no recurrence. Average age of surgery was 9.5 months. Most common post op complication was hypertrophic scar (3/12). Recurrence was only seen in the linear closure cases (4/12). CONCLUSIONS Midline Cervical Cleft is a rare entity with less than 200 cases in the literature. We believe the double z-plasty closure and complete excision of the fibrous cord results in reproducible restoration of neck contour and prevents cord recurrence, and should be considered the standard method for surgical excision of MCC.
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Affiliation(s)
- Jill N D'Souza
- Division of Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Chicago, IL, 60611, USA; Depart of Otolaryngology, Texas Children's Hospital, 17580 I-45 South, Suite WM410, The Woodlands, TX, 77384, USA.
| | - Taher Valika
- Division of Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Chicago, IL, 60611, USA; Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, USA.
| | - John Maddalozzo
- Division of Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Chicago, IL, 60611, USA; Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, USA.
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Fan Y, Matthews H, Kilpatrick N, Claes P, Clement J, Penington A. Facial morphology and growth following surgery for congenital midline cervical cleft patients. Int J Oral Maxillofac Surg 2018; 47:437-441. [PMID: 29373199 DOI: 10.1016/j.ijom.2017.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/01/2017] [Accepted: 12/14/2017] [Indexed: 11/16/2022]
Abstract
Congenital midline cervical cleft (CMCC) is a rare condition that consists of a cutaneous midline neck lesion with a sinus extending inferiorly towards the sternum. A fibrous band that extends superiorly to the mandible is a consistent feature of the condition. Restriction of growth of the mandible, possibly due to incomplete removal of the band, is the most significant long-term problem. It remains unclear whether early removal of the fibrous band might allow catch-up growth of the mandible. This study utilized non-invasive three-dimensional photographs to objectively evaluate the facial growth of six CMCC patients. The growth of these CMCC patients was compared to the average growth of age- and sex-matched controls from a database of three-dimensional facial photographs of clinically normal subjects. After surgical removal of the fibrous cord, CMCC patients experience growth in the chin at the same rate as in the normal population; no evidence was found for catch-up growth. As a result, individuals with CMCC are likely to require further surgical intervention to correct the residual retrognathia on completion of facial growth. Early excision of the lesion including aggressive resection of the fibrous band is still recommended, as this should optimize the early growth of the mandible in infancy.
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Affiliation(s)
- Y Fan
- Department of Dentistry, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - H Matthews
- Murdoch Children's Research Institute, Melbourne, Australia; The University of Melbourne Department of Paediatrics at the Royal Children's Hospital, Melbourne, Australia
| | - N Kilpatrick
- Murdoch Children's Research Institute, Melbourne, Australia; The University of Melbourne Department of Paediatrics at the Royal Children's Hospital, Melbourne, Australia
| | - P Claes
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Electrical Engineering, KU Leuven, Leuven, Belgium; ESAT/PSI, Medical Image Computing, UZ Leuven, Leuven, Belgium; Medical Imaging Research Centre, Leuven, Belgium
| | - J Clement
- Department of Dentistry, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Cranfield University, Cranfield, Bedfordshire, UK
| | - A Penington
- Murdoch Children's Research Institute, Melbourne, Australia; The University of Melbourne Department of Paediatrics at the Royal Children's Hospital, Melbourne, Australia.
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Achard S, Leroy X, Fayoux P. Congenital midline cervical cleft: A retrospective case series of 8 children. Int J Pediatr Otorhinolaryngol 2016; 81:60-4. [PMID: 26810292 DOI: 10.1016/j.ijporl.2015.12.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/13/2015] [Accepted: 12/16/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Congenital midline cervical cleft is a rare developmental abnormality of the ventral neck of unclear etiology. It consists of a midline skin defect. This study reports a case series of 8 patients with congenital midline cervical cleft. METHODS Retrospective review chart including all children referred with congenital midline cervical cleft over 5 years in tertiary center. The study was conducted to determine the presence of associated malformations, to specify the cleft pathology, to analyze the nature of associated cysts, and to discuss surgical procedure. RESULTS Eight patients ranged from 3 days to 5 years. Two had an associated cervical midline cyst, 3 had a significant micrognatia. Pathological observations were in favor of a branchial origin. There was no recurrence of cervical contraction after a mean follow-up of 20 months. CONCLUSION Congenital midline cervical cleft is a rare and generally isolated congenital malformation. It does not require either extensive assessment or specific genetic. Described associated cysts might be part of the cleft and not bronchogenic or thyroglossal cysts. Early surgical excision reduces cervical contracture, but linear or Z-plasty closure is still debated.
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Affiliation(s)
- Sophie Achard
- Department of Pediatric Otolaryngology-Head Neck Surgery, Jeanne de Flandre Children's Hospital, University Hospital, Lille, France.
| | - Xavier Leroy
- Department of Pathology, University Hospital, Lille, France
| | - Pierre Fayoux
- Department of Pediatric Otolaryngology-Head Neck Surgery, Jeanne de Flandre Children's Hospital, University Hospital, Lille, France
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Cudzilo D, Matthews-Brzozowska T, Obloj B. Craniofacial Morphology in Midline Cervical Cleft: Case Report and Review of Literature. Cleft Palate Craniofac J 2015; 54:235-241. [PMID: 26418149 DOI: 10.1597/15-126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Congenital midline cervical cleft is a rare anomaly of the neck. This paper presents the case of a boy diagnosed with this disorder in which a preliminary orthodontic treatment was implemented. The craniofacial anomalies associated with this malformation produced a defect that could only be successfully treated through the implementation of orthodontic and surgical treatments. In this case, congenital midline cervical cleft was accompanied by certain disorders within the facial structures of the skull, primarily mandibular retrusion, flattening of the contour of the mandibular base, and a steep angle between the cranial base and the mandibular plane.
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Abstract
Introduction. Midline cervical cleft is a rare congenital malformation which nonetheless has a classic presentation. This study presents one of the largest single series of new patients with MCC and provides an exhaustive review and catalogue of publications from the international literature. Materials and Methods. Retrospective chart review performed in two academic medical centers and literature review performed with primary verification of all quoted references. Results. Ten patients with MCC were identified (8 boys and 2 girls). All patients presented with the classic findings of this congenital anomaly, and the length of the skin defect correlated with an increase in the patient's age. Surgical excision was complete in all cases. Thorough international literature review yielded only 195 verifiable previously reported cases. Conclusions. This is one of the largest series of new patients with midline cervical cleft presented in the world literature. Although rare (with less than 200 cases published to date) this entity does have a reliable presentation that should lead to rapid and accurate diagnosis. Complete surgical excision at an early age is appropriate since the anomaly increases in length commensurate with the patient's age.
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