Atypical first branchial cleft fistula: A case report

•

First branchial cleft fistula are rare and can be in form of cyst or fistula.

•

Clinically, they may masquerade as parotid tumours or as otitis with ear drainage.

•

Its management is surgical excision keeping the tract cyst of the fistula intact.

•

Superficial parotidectomy with facial nerve dissection is the key to complete excision of the cleft fistula with preservation of the facial nerve.

Introduction

First branchial cleft anomalies (FBCA) are rare. They have an estimated incidence of 1 in 100,000. Type I are those that embryologically duplicate the membrane (cutaneous) external auditory canal.

The aim of this case is to describe an unusual path of a type II first branchial cleft fistula tract in a 3 years old child and its surgical management in the academic hospital of Casablanca.

Case presentation

This case is about a 3 year old girl who presented to the Ear Nose Throat (ENT) consultation for recurrent right lateral cervical infection. Clinical examination found an unsightly scar attached to an orifice giving pus located near the right mandibular angle suggesting type II first branchial cleft anomaly.

Surgical excision was performed under general anesthesia by the superficial parotidectomy approach, the facial nerve was identified and preserved. The fistula cord was dissected and followed, it went under the facial nerve and the parorid gland to end under the digastric muscle where we tied it up. The postoperative check-up did not show any complications. The follow-up period was 12 months; the clinical examination did not find any sign of recurrence.

Conclusion

First branchial cleft fistula are rare and can be in form of cyst or fistula. Its management is surgical excision keeping the tract cyst of the fistula intact with facial nerve preservation.

Spindle cell hemangioma in the infratemporal fossa: A unique case report

•

Spindle cell hemangioma (SCH) is a rare vascular tumor that was considered to be intermediate -or low-grade malignancy, with biological behavior between a hemangioma and angiosarcoma.

•

The SCH is commonly found in the distal extremities. So far, only 16 cases have been described in the head and neck area. No previous case has been described in the infratemporal fossa.

•

SCH shows a proliferation of spindle cells composed of endothelial cells, pericytes and fibroblasts between dilated vascular spaces and immunoreactivity to endothelial markers.

Introduction

Spindle cell hemangioma (SCH) is a rare vascular tumor which was first described in 1986. It affects mostly the distal extremities. The head and neck are rarely involved. This article reports the first case of SCH in the infratemporal fossa.

Presentation of case

A 41-year-old woman presented with an 8-month history of right cheek swelling. Facial CT scan and MRI showed an intensely and heterogeneously enhancing tumor of the infratemporal fossa suggesting an angiomatous neoplasm. The mass was excised surgically through an anterior maxillary approach. The histopathological and immunohistochemistry analysis revealed a SCH.

Conclusion

This case report presents a unique presentation of a Spindle cell hemangioma in an unexpected location of the head and neck region. it underlines the importance for clinicians and pathologists to consider the Spindle cell hemangioma as a possible etiological diagnosis of infratemporal fossa tumors.