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Ferraro T, Pershad AR, Arora S, Lee E, Joshi A. The utility of ultrasonographic surveillance in management of a presumed branchial cleft cyst later confirmed HPV-associated oropharyngeal cancer. Oral Oncol 2024; 151:106743. [PMID: 38460289 DOI: 10.1016/j.oraloncology.2024.106743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 03/11/2024]
Abstract
While branchial cleft cysts are often considered benign pathologies, the literature discusses cases of squamous cell carcinoma (SCC) arising from these cystic lesions as either a primary or metastatic tumor. We illustrate our institutional experience and review the current literature to identify recommendations for best diagnostic, surveillance, and treatment guidelines for SCC identified in a branchial cleft cyst. A 61-year-old male presented with a right sided neck mass, with suspicion of a branchial cleft cyst due to benign findings on fine needle aspiration. Following surgical excision, a focus of SCC was found on surgical pathology. Despite PET/CT and flexible laryngoscopy, no primary tumor was identified prompting routine surveillance every 3 months with cervical ultrasonography and flexible nasolaryngoscopy. Two and a half years following his initial presentation, pathologic right level II lymphadenopathy was detected on ultrasound without evidence of primary tumor. Subsequent transoral robotic surgery with right tonsillectomy and partial pharyngectomy, with right lateral neck dissection revealed a diagnosis of pT1N1 HPV-HNSCC and he was referred for adjuvant chemotherapy and radiation. To our knowledge there are less than 10 cases of confirmed HPV-associated oropharyngeal SCC arising from a branchial cleft cyst. Here we demonstrate the utility of ultrasound as a surveillance tool and emphasize a higher index of suspicion for carcinoma in adult patients with cystic neck masses.
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Affiliation(s)
- Tatiana Ferraro
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, 2300 M St NW, 4(th) Floor, Washington, DC 20037, USA; Drexel University College of Medicine, Philadelphia, PA, USA.
| | - Alisha R Pershad
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, 2300 M St NW, 4(th) Floor, Washington, DC 20037, USA
| | - Shaleen Arora
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, 2300 M St NW, 4(th) Floor, Washington, DC 20037, USA
| | - Esther Lee
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, 2300 M St NW, 4(th) Floor, Washington, DC 20037, USA
| | - Arjun Joshi
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, 2300 M St NW, 4(th) Floor, Washington, DC 20037, USA
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Raghavan M, Carr MM. Age-related outcomes after pediatric branchial cleft cyst excision via NSQIP-P. Int J Pediatr Otorhinolaryngol 2024; 176:111811. [PMID: 38048733 DOI: 10.1016/j.ijporl.2023.111811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/21/2023] [Accepted: 11/26/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE Branchial cleft cysts present at varying ages; sometimes excision is delayed because of concern about operating in small children. Our goal was to determine if outcomes and complications differed among pediatric age groups. STUDY DESIGN Retrospective, cross-sectional. SETTING American College of Surgeons' National Surgical Quality Improvement Pediatric database. METHODS Patients who underwent a branchial cleft cyst excision between 2016 and 2020 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Pediatric database. Patients with CPT code 42,815: 'excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues and/or into the pharynx' as their primary procedure were included. Variables of interest included patient demographics, comorbidities, pre-operative risk factors and complications. RESULTS 2267 patients with median age of 3.9 (IQR: 7.4, range: 0.04-17.9) years were included. The most common pre-operative risk factors were 149 (7 %) patients with prematurity, 136 (6 %) with developmental delay, 135 (6 %) with congenital malformation, and 128 (6 %) with open wound or wound infection. 68 (3 %) patients experienced at least one post-operative complication, with 73 post-operative complications documented in total. Surgical site infections were the most common complications with 49 (67.1 %) superficial infections, 11 (15.1 %) deep infections, and 4 (5.5 %) organ/space infections. Surgical site infections were the most common reason for related readmission. Duration of anesthesia and operative time increased significantly as patient age increased (p < .001 for both). There was no significant correlation between age and complication incidence. CONCLUSION Branchial cleft cyst excision is a relatively safe operation with a low complication rate, even in young pediatric populations.
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Affiliation(s)
- Maya Raghavan
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, 14209, USA
| | - Michele M Carr
- Department of Otolaryngology-Head and Neck Surgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, 14209, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Evans V, Prades E, Passant C, Owens D, Harris A. Stratifying risk of malignancy in cystic lateral neck lumps: a multivariant analysis of demographic, radiological and histological investigation factors and the development of a patient-centred risk-predictive tool for malignancy. J Laryngol Otol 2024; 138:99-104. [PMID: 37218625 DOI: 10.1017/s002221512300097x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Management of lateral cystic neck masses with no apparent upper aerodigestive tract primary tumour in adults is controversial. Imaging modalities and fine needle aspiration cytology often struggle to distinguish the presence of malignancy. METHOD This study entailed a multicentre retrospective review of all patients with isolated lateral cystic neck masses from 2012 to 2018 in three Welsh health boards, utilising demographic data and first-line investigations (ultrasound scanning and fine needle aspiration cytology) to develop an evidence-based predictive tool for risk of malignancy. RESULTS It was found that 29.1 per cent of cystic lesions were malignant on final histology. Age, male gender, non-benign ultrasound scan findings and fine needle aspiration cytology were significant risk factors on univariate analysis. The final multivariate analysis predicted a risk of malignancy ranging from 2.1 to 65.0 per cent depending on the covariate pattern. Smoking status was non-significant. CONCLUSION A rigorous, risk-stratified approach to the management of these patients should aid the clinician in minimising morbidity and optimising resources.
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Affiliation(s)
- Victoria Evans
- Department of Otolaryngology, Aneurin Bevan University Health Board, Newport, Wales, UK
| | - Eduard Prades
- Department of Otolaryngology, Betsi Cadwaladr University Health Board, Rhyl, Wales, UK
| | - Carl Passant
- Department of Otolaryngology, Aneurin Bevan University Health Board, Newport, Wales, UK
| | - David Owens
- Department of Otolaryngology, Cardiff and Vale University Health Board, Cardiff, Wales, UK
| | - Andrew Harris
- Department of Otolaryngology, Aneurin Bevan University Health Board, Newport, Wales, UK
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Yang X, Sun K, Ren W, Zhi K. First branchial cleft anomaly in a 5-year-old child. Asian J Surg 2023; 46:5032-5034. [PMID: 37419819 DOI: 10.1016/j.asjsur.2023.06.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/09/2023] [Indexed: 07/09/2023] Open
Affiliation(s)
- Xiaoxia Yang
- Department of Oral and Maxillofacial Reconstruction, The Affiliated Hospital of Qingdao University, Qingdao, 266555, China; School of Stomatology of Qingdao University, Qingdao, 266003, China; Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266555, China
| | - Kai Sun
- Department of Oral and Maxillofacial Reconstruction, The Affiliated Hospital of Qingdao University, Qingdao, 266555, China; School of Stomatology of Qingdao University, Qingdao, 266003, China; Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266555, China
| | - Wenhao Ren
- Department of Oral and Maxillofacial Reconstruction, The Affiliated Hospital of Qingdao University, Qingdao, 266555, China; Key Lab of Oral Clinical Medicine, The Affiliated Hospital of Qingdao University, Qingdao, 266555, China; Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266555, China.
| | - Keqian Zhi
- Department of Oral and Maxillofacial Reconstruction, The Affiliated Hospital of Qingdao University, Qingdao, 266555, China; Key Lab of Oral Clinical Medicine, The Affiliated Hospital of Qingdao University, Qingdao, 266555, China; Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266555, China.
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Alsharhan SS, Alghuneem AA, Alrusayyis DF, Aljahli MS. Atypical site of nasopharyngeal branchial cleft cyst: A case of an unusual age presentation. J Family Community Med 2023; 30:145-147. [PMID: 37303845 PMCID: PMC10252642 DOI: 10.4103/jfcm.jfcm_342_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/24/2023] [Accepted: 02/03/2023] [Indexed: 06/13/2023] Open
Abstract
Nasopharyngeal branchial cleft cysts (NBC) are generally single, unilateral, and asymptomatic. They may get infected or produce obstructive symptoms as it enlarges. The definitive diagnosis is usually confirmed by Magnetic resonance imaging (MRI) and histopathology. A 54-year-old male patient presented with progressive bilateral nasal obstruction, more on the right side, associated with hyponasal voice and postnasal discharge of 2 years' duration. A cystic mass was found by nasal endoscopy on the lateral right side of the nasopharynx, extending to the oropharynx, and was confirmed with MRI findings. Uneventful total surgical excision and marsupialization were done with follow up of nasopharyngeal endoscopic examination on each visit. The pathological features and the site of the cyst were compatible with a second branchial cleft cyst. Although rare, NBC should be considered one of the differential diagnoses of nasopharyngeal tumors. Surgical excision and marsupialization are the main treatment with low complication and recurrence rates.
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Affiliation(s)
- Salma S. Alsharhan
- Department of Otorhinolaryngology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Aishah A. Alghuneem
- Department of College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Danah F. Alrusayyis
- Department of College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Marwah S. Aljahli
- Department of College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- King Fahad Hospital of the University, Al Khobar, Saudi Arabia
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Luo S, Luo T, Huang Y, Zhang W. Intrathyroid branchial-cleft cyst. Asian J Surg 2023; 46:1268-1269. [PMID: 36117065 DOI: 10.1016/j.asjsur.2022.08.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/16/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Siyi Luo
- Department of Pathology, Suining Central Hospital, Suining, Sichuan, China
| | - Ting Luo
- Department of Pathology, Suining Central Hospital, Suining, Sichuan, China
| | - Yalan Huang
- Department of Pathology, Suining Central Hospital, Suining, Sichuan, China
| | - Weishan Zhang
- Department of Pathology, Suining Central Hospital, Suining, Sichuan, China.
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Guo Z, Wu H, Nie Z, Li J. Solitary cystic lymph node metastasis of papillary thyroid microcarcinoma mimicking a branchial cleft cyst: A case report. Asian J Surg 2023:S1015-9584(23)00234-8. [PMID: 36858937 DOI: 10.1016/j.asjsur.2023.02.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/15/2023] [Indexed: 03/03/2023] Open
Affiliation(s)
- Zhenzhen Guo
- Department Ⅲ of General Surgery, Xi'an Daxing Hospital, No.353, North Labor Road, Lianhu District, Xi'an, 710016, China
| | - Hong Wu
- Department Ⅲ of General Surgery, Xi'an Daxing Hospital, No.353, North Labor Road, Lianhu District, Xi'an, 710016, China
| | - Zunzhen Nie
- Department of Pathology, Xi'an Daxing Hospital, No.353, North Labor Road, Lianhu District, Xi'an, 710016, China
| | - Jinmao Li
- Department Ⅲ of General Surgery, Xi'an Daxing Hospital, No.353, North Labor Road, Lianhu District, 710016, Xi'an, China.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Pimpalkhute KM, Parikh P, Jha R. A Rare Case of Parotid Swelling Presenting as Branchial Cleft Cyst. Indian J Otolaryngol Head Neck Surg 2022; 74:5747-5752. [PMID: 36742474 PMCID: PMC9895621 DOI: 10.1007/s12070-020-02353-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/23/2020] [Indexed: 02/07/2023] Open
Abstract
First brachial cleft cyst arise due to incomplete fusion of first and second brachial arches. It is classified into type 1, which is thought to arise from the duplication of the membranous external ear canal and are composed of ectoderm only, and type 2 that have both ectoderm and mesoderm which presents as parotid swelling. As it is rare it is easily misdiagnosed and mismanaged. First branchial cleft cyst are rare causes of parotid swellings as in this case reports.
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Affiliation(s)
- Ketki Madhav Pimpalkhute
- Department of Otorhinolaryngology and Head & Neck Surgery, Seth V.C. Gandhi & M.A. Vora Municipal General (Rajawadi) hospital, 7, M.G road, Ghatkopar, Mumbai, 400077 Maharashtra India
| | - Pragnya Parikh
- Department of Otorhinolaryngology and Head & Neck Surgery, Seth V.C. Gandhi & M.A. Vora Municipal General (Rajawadi) hospital, 7, M.G road, Ghatkopar, Mumbai, 400077 Maharashtra India
| | - Rakhi Jha
- Department of Otorhinolaryngology and Head & Neck Surgery, Seth V.C. Gandhi & M.A. Vora Municipal General (Rajawadi) hospital, 7, M.G road, Ghatkopar, Mumbai, 400077 Maharashtra India
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Hammarstedt Nordenvall L, Jörtsö E, von Beckerath M, Tani E, Nordemar S, Bark R. Prevalence of cystic metastases in a consecutive cohort of surgically removed branchial cleft cysts. Acta Otolaryngol 2022; 142:100-105. [PMID: 34962438 DOI: 10.1080/00016489.2021.2016951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Solitary cystic lesion of the neck may often be the only initial presenting symptom for branchial cleft cysts and cystic metastases. AIMS/OBJECTIVES To analyse the malignancy rate detected in patients undergoing surgical treatment for lateral branchial cleft cyst. MATERIAL AND METHODS The records of all patients with surgical procedure code ENB40 (Excision of lateral branchial cleft cyst- or fistula) between 2003 and 2019 were reviewed. After excluding 150 patients, 436 patients were included for final analysis. Re-evaluation of the cytology including HPV-analysis was performed in those who had a malignant cyst. RESULTS Cystic metastases were demonstrated histologically after surgical excision in 13 patients (3%). In patients over 18 years of age, the prevalence of cystic metastasis regardless of the primary tumour type was 3.3%. CONCLUSION AND SIGNIFICANCE When the investigation protocol for solitary cystic lesions of the neck is followed, the negative predictive value for malignancy is 97%. All adult patients with a cytologic verified diagnosis of branchial cyst should be examined with HPV-analysis of the cystic sample before excision of the cyst. Failure of predicting a malignancy is often associated with cytology of poor cellularity which may be improved by more frequent use of ultrasound guided fine-needle aspiration cytology (FNAC).
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Affiliation(s)
- Lalle Hammarstedt Nordenvall
- Department of Clinical Sciences Intervention and Technology, Division of Ear Nose and Throat Diseases, Karolinska Institutet, Stockholm, Sweden
- Department of Head and Neck Surgery, Medical Unit Head Neck Lung and Skin Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Evelina Jörtsö
- Department of Clinical Sciences Intervention and Technology, Division of Ear Nose and Throat Diseases, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Mathias von Beckerath
- Department of Head and Neck Surgery, Medical Unit Head Neck Lung and Skin Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Otolaryngology, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden
| | - Edneia Tani
- Department of Clinical Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Sushma Nordemar
- Department of Clinical Sciences Intervention and Technology, Division of Ear Nose and Throat Diseases, Karolinska Institutet, Stockholm, Sweden
- Department of Head and Neck Surgery, Medical Unit Head Neck Lung and Skin Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Rusana Bark
- Department of Clinical Sciences Intervention and Technology, Division of Ear Nose and Throat Diseases, Karolinska Institutet, Stockholm, Sweden
- Department of Head and Neck Surgery, Medical Unit Head Neck Lung and Skin Cancer, Karolinska University Hospital, Stockholm, Sweden
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Venkatakarthikeyan C, Nair S, Gowrishankar M, Rao S. Robotic Surgery in Head and Neck in Pediatric Population: Our Experience. Indian J Otolaryngol Head Neck Surg 2020; 72:98-103. [PMID: 32158664 DOI: 10.1007/s12070-019-01768-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022] Open
Abstract
Robot assisted surgery of the head and neck is a relatively novel approach in the management of head and neck tumors. There are very few reported cases of robot-assisted surgery of the head and neck in pediatric population in the world literature and no report of such procedures in the Indian subcontinent. In this article we present three such cases we performed for the first time in the country. The first case is that of second branchial cleft cyst, the second is a 4-year-old boy with a tongue base cyst and the third patient is a 12-year-old girl with left parotid gland tumor. All the patients underwent successful Robotic surgeries. Case 1 underwent robotic excision of the cyst through a retroauricular hairline incision. Case 2 underwent transoral robotic excision of the tongue base cyst. Case 3 underwent robotic excision of the tumor through a modified facelift incision. The mean docking time for the robot was 12.33 min and approximate blood loss was less than 10 ml in all cases. The patient and their parents were extremely satisfied with the cosmetic outcomes of the scarless surgery. Robot assisted surgery has the advantage of performing minimally invasive procedures within constrained spaces especially in children. The multiarticulated endowrist movements of the robotic arms combined with higher magnification and three-dimensional depth perception allows a precise surgery with better visualization in otherwise inaccessible areas resulting in better surgical outcome. With exceptional advantages of scarless surgery, minimal blood loss and postoperative pain and better surgeon ergonomics, robotic technique is an effective and feasible option in Pediatric Head and neck Surgery.
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Affiliation(s)
- C Venkatakarthikeyan
- Department of Otorhinolaryngology and Head and Neck Surgery, Apollo Main Hospital, Room No. 25B Sindoori Block, Ground Floor, 21 Greams Lane, Off Greams Road, Chennai, 600006 India
| | - Swati Nair
- Department of Otorhinolaryngology and Head and Neck Surgery, Apollo Main Hospital, C-304 Pawitra Apartments, Vasundhara Enclave, Delhi, 110096 India
| | - M Gowrishankar
- Department of Otorhinolaryngology and Head and Neck Surgery, Apollo Main Hospital, Room No. 25B Sindoori Block, Ground Floor, 21 Greams Lane, Off Greams Road, Chennai, 600006 India
| | - Soorya Rao
- Department of Otorhinolaryngology and Head and Neck Surgery, Apollo Main Hospital, C-304 Pawitra Apartments, Vasundhara Enclave, Delhi, 110096 India.,Department of Otorhinolaryngology and Head and Neck Surgery, Apollo Main Hospital, S2, Gopalakrishna Flats, No. 14/21, Lake View Road, West Mambalam, Chennai, 600033 India
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Gür H, Arpacı RB, İsmi O, Dağ A, Vayısoğlu Y, Görür K. Papillary Thyroid Carcinoma Spreading into Branchial Cleft Cyst. Turk Arch Otorhinolaryngol 2019; 57:95-98. [PMID: 31360928 DOI: 10.5152/tao.2019.4151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 04/28/2019] [Indexed: 11/22/2022] Open
Abstract
Papillary thyroid carcinoma (PTC) is the most common type of thyroid malignancy and it can cause cystic metastasis to the neck region. Branchial cleft cysts (BCCs) are among the most commonly encountered congenital cystic neck masses. PTC metastasis into BCC has been rarely reported in the literature. In this case report we report a patient presenting with a cystic neck mass for which fine needle aspiration biopsy was reported as benign cytology and eventually was diagnosed as PTC metastasis to the BCC. The importance of investigating the thyroglobulin levels in fine needle aspiration materials of cystic neck masses for early diagnosis of possible PTC metastasis is specifically emphasized.
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Affiliation(s)
- Harun Gür
- Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey
| | | | - Onur İsmi
- Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey
| | - Ahmet Dağ
- Department of General Surgery, Mersin University School of Medicine, Mersin, Turkey
| | - Yusuf Vayısoğlu
- Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey
| | - Kemal Görür
- Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey
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14
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Mattioni J, Azari S, Hoover T, Weaver D, Chennupati SK. A cross-sectional evaluation of outcomes of pediatric branchial cleft cyst excision. Int J Pediatr Otorhinolaryngol 2019; 119:171-176. [PMID: 30735909 DOI: 10.1016/j.ijporl.2019.01.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/16/2019] [Accepted: 01/19/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To examine complications following pediatric branchial cleft cyst excision by surgical specialty, demographics, and comorbid conditions. METHODS A retrospective review of the National Surgical Quality Improvement Program database was performed. Pediatric cases from January 1, 2015 through May 1, 2017 with a current procedural terminology code of 42810 (excision branchial cleft cyst or vestige, confined to skin and subcutaneous tissues) or 42815 (excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues and/or into the pharynx) were included. Statistical analysis was performed to assess associations between complications and surgical specialty, demographics, and comorbidities. RESULTS Of the 895 cases that met inclusion criteria, the median age was two years and there was an approximately equal number of males (46.8%) and females (53.2%). Forty-five patients (5.0%) experienced at least one 30-day complication, the most predominant of which was superficial surgical site infection. There was no statistically significant difference between complications and surgical specialty, complications and patient demographics, or complications and depth of excision. There was a statistically significant difference (p = 0.05) in the percentage of patients with a past medical history of developmental delay between those with at least one complication (11.1%) compared to those without any complications (4.2%). CONCLUSION AND RELEVANCE Branchial cleft excision is a generally safe procedure across surgical specialties and patient demographics. There is an association between a history of developmental delay and 30-day postoperative complications.
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Affiliation(s)
- Jillian Mattioni
- Otolaryngology Head and Neck Surgery Resident, Department of Otolaryngology- Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, 4170 City Avenue, Philadelphia, PA, 19131, USA.
| | - Sarah Azari
- University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA.
| | - Travis Hoover
- Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033, USA.
| | - Daniel Weaver
- Lehigh University, 27 Memorial Dr W Bethlehem, PA, 18015, USA.
| | - Sri Kiran Chennupati
- Pediatric Otolaryngology, Lehigh Valley Children's Hospital, 1210 S Cedar Crest Blvd, Allentown, PA, 18103, USA.
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15
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Pitak-Arnnop P, Subbalekha K, Sirintawat N, Auychai P, Klaisiri A, Neff A. Intraoperative injection of combined fibrin sealant and methylene blue dye for surgery of branchial cleft cysts: A case report. J Stomatol Oral Maxillofac Surg 2019; 120:378-382. [PMID: 30797901 DOI: 10.1016/j.jormas.2019.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 02/05/2019] [Accepted: 02/13/2019] [Indexed: 12/17/2022]
Abstract
Differential diagnosis of a lateral neck mass, especially in paediatric patients, should include branchial cleft cysts (BrCC). It is often difficult to identify and completely resect all cystic components, especially when the lesion becomes infected and/or gigantic. Incomplete excision increases the likelihood of recurrences. We reported a simple technique to facilitate the BrCC resection. Tisseel fibrin glue (FG: Baxter AG, Vienna, Austria) was mixed with methylene blue dye in inverse portion to the cyst size and/or the FG volume before injecting into the cystic lumen. After polymerisation of the dyed glue, the lesion was better visualised and extirpated in toto with the aid of the dye colour and gelatinisation by FG. An up-to-date diagnostic and therapeutic algorithm for BrCC was also presented.
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Affiliation(s)
- P Pitak-Arnnop
- Department of Oral and Maxillofacial, UKGM GmbH, University Hospital of Marburg, Faculty of Medicine, Philipps University, Marburg, Germany.
| | - K Subbalekha
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - N Sirintawat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - P Auychai
- Department of Paediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - A Klaisiri
- Divisions of Operative Dentistry and Material Science, Faculty of Dentistry, Thammasat University, Pathumthani, Thailand
| | - A Neff
- Department of Oral and Maxillofacial, UKGM GmbH, University Hospital of Marburg, Faculty of Medicine, Philipps University, Marburg, Germany
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16
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Yehuda M, Schechter ME, Abu-Ghanem N, Golan G, Horowitz G, Fliss DM, Abu-Ghanem S. The incidence of malignancy in clinically benign cystic lesions of the lateral neck: our experience and proposed diagnostic algorithm. Eur Arch Otorhinolaryngol. 2018;275:767-773. [PMID: 29282522 DOI: 10.1007/s00405-017-4855-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 12/21/2017] [Indexed: 12/13/2022]
Abstract
AIM Solitary cystic masses of the lateral neck in an adult patient can pose a diagnostic dilemma. Malignancy must be ruled out since metastases arising from H&N cancers may mimic the presentation of benign cystic masses. Only a small number of studies have investigated the diagnostic management and malignancy rate of clinically benign solitary cervical cystic lesions. There are no established guidelines for the diagnostic evaluation. METHODS Retrospective review of the clinical, cytological, radiological, and pathological records of all adult patients (> 18 years) operated on for second branchial cleft cysts (BrCC) between 1/2008-2010/2016. Patients with apparent primary H&N malignancy, history of H&N cancer or irradiation, preoperative fine needle aspiration (FNA) of highly suggestive or confirmed malignancy, missing pertinent data, or age less than 18 years were excluded from analysis. RESULTS 28 patients were diagnosed as having BrCC. The diagnosis was based on clinical findings, FNA cytology, and typical sonographic features. The histologic analysis determined an overall rate of malignancy of 10.7% (3/28): two patients had metastatic papillary thyroid carcinoma, and one patient had metastatic tonsillar squamous cell carcinoma. Purely cystic features on pre-operative ultrasound was the only significant predictor for true BrCC on final histology (p = .02). CONCLUSIONS Occult malignancy is not rare among adult patients presenting with a solitary cystic mass of the lateral neck. A diagnostic algorithm is proposed. Further studies are needed to establish the appropriate workup and management of an adult patient presenting with a solitary cystic mass of the lateral neck.
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17
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Hosokawa T, Yamada Y, Takahashi H, Sato Y, Tanami Y, Suzuki K, Kawashima H, Oguma E. Congenital dermoid fistulas of the anterior chest region (CDFACR): usefulness of sonography for complete resection. Radiol Case Rep 2017; 12:628-631. [PMID: 28828140 PMCID: PMC5552003 DOI: 10.1016/j.radcr.2017.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 11/27/2022] Open
Abstract
Congenital dermoid fistulas of the anterior chest regions (CDFACRs) consist of a skin orifice at the anterior border of the sternocleidomastoid muscle with fistulas extending caudally in the subcutaneous tissue near the sternoclavicular joint. We report 2 pediatric CDFACR cases with pathognomonic sonography findings. By using sonography, we could diagnose the fistulas as CDFACRs by focusing on their location and direction and could reveal the distal side for complete resection. We suggest that sonography, which does not involve radiation or require sedation, is a better choice for the initial examination of CDFACRs than computed tomography or MRI.
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Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, 2100 Magome, Iwatsuki, Saitama 339-8551, Japan
| | - Yoshitake Yamada
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Hiroaki Takahashi
- Department of Radiology, Saitama Children's Medical Center, 2100 Magome, Iwatsuki, Saitama 339-8551, Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children's Medical Center, 2100 Magome, Iwatsuki, Saitama 339-8551, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, 2100 Magome, Iwatsuki, Saitama 339-8551, Japan
| | - Keisuke Suzuki
- Department of Surgery, Saitama Children's Medical Center, Iwatsuki, Saitama, Japan
| | - Hiroshi Kawashima
- Department of Surgery, Saitama Children's Medical Center, Iwatsuki, Saitama, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, 2100 Magome, Iwatsuki, Saitama 339-8551, Japan
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18
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Sellami M, Ghorbel A. Branchial cleft cyst: a case report. Pan Afr Med J 2017; 26:102. [PMID: 28491233 PMCID: PMC5409998 DOI: 10.11604/pamj.2017.26.102.11895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 02/15/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
- Moncef Sellami
- Department of Otorhinolaryngology-Head and Neck Surgery Habib Bourguiba, University Hospital, Sfax, Tunisia.,Sfax Medical School, University of Sfax, Sfax, Tunisia
| | - Abdelmonem Ghorbel
- Department of Otorhinolaryngology-Head and Neck Surgery Habib Bourguiba, University Hospital, Sfax, Tunisia.,Sfax Medical School, University of Sfax, Sfax, Tunisia
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Sai-Guan L, Min-Han K, Kah-Wai N, Mohamad-Yunus MR. Nasopharyngeal Carcinoma with Cystic Cervical Metastasis Masquerading as Branchial Cleft Cyst: A Potential Pitfall in Diagnosis and Management. Iran J Otorhinolaryngol 2017; 29:117-120. [PMID: 28393061 PMCID: PMC5380399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Most metastatic lymph nodes from head and neck malignancy are solid. Cystic nodes are found in 33% - 61% of carcinomas arise from Waldeyer's ring, of which only 1.8% - 8% originate are from the nasopharynx. Some cystic cervical metastases were initially presumed to be branchial cleft cyst. This case report aims to highlight the unusual presentation of cystic cervical metastasis secondary to nasopharyngeal carcinoma in a young adult. The histopathology, radiological features and management strategy were discussed. CASE REPORT A 36-year-old man presented with a solitary cystic cervical swelling, initially diagnosed as branchial cleft cyst. Fine needle aspiration yielded 18 ml of straw-coloured fluid. During cytological examination no atypical cells were observed. Computed tomography of the neck showed a heterogeneous mass with multiseptation medial to the sternocleidomastoid muscle. Histopathological examination of the mass, post excision, revealed a metastatic lymph node. A suspicious mucosal lesion at the nasopharynx was detected after repeated thorough head and neck examinations and the biopsy result confirmed undifferentiated nasopharyngeal carcinoma. CONCLUSION Cystic cervical metastasis may occur in young patients under 40 years. The primary tumour may not be obvious during initial presentation because it mimicks benign branchial cleft cyst clinically. Retrospective review of the computed tomography images revealed features that were not characteristic of simple branchial cleft cyst. The inadequacy of assessment and interpretation had lead to the error in diagnosis and subsequent management. Metastatic head and neck lesion must be considered in a young adult with a cystic neck mass.
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Affiliation(s)
- Lum Sai-Guan
- Department of Otorhinolaryngology – Head and Neck Surgery, University Kebangsaan Malaysia Kebangsaan Medical Centre (UKMMC), Kuala Lumpur, Malaysia.,Corresponding Author: Department of Otorhinolaryngology – Head and Neck Surgery, University Kebangsaan Malaysia Kebangsaan Medical Centre (UKMMC), Kuala Lumpur, Malaysia. E-mail:
| | - Kong Min-Han
- Department of Otorhinolaryngology – Head and Neck Surgery, University Kebangsaan Malaysia Kebangsaan Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - Ngan Kah-Wai
- Department of Pathology, Hospital Serdang, Selangor, Malaysia.
| | - Mohd-Razif Mohamad-Yunus
- Department of Otorhinolaryngology – Head and Neck Surgery, University Kebangsaan Malaysia Kebangsaan Medical Centre (UKMMC), Kuala Lumpur, Malaysia
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20
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Abadi P, Johansen A, Godballe C, Gerke O, Høilund-Carlsen PF, Thomassen A. 18F-FDG PET/CT to differentiate malignant necrotic lymph node from benign cystic lesions in the neck. Ann Nucl Med 2016; 31:101-108. [PMID: 27921286 DOI: 10.1007/s12149-016-1142-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/15/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Patients presenting with cystic lesions in the neck without obvious signs of malignancy constitute a diagnostic challenge since fine needle aspiration is often insufficient and a diagnosis may not be reached until surgical resection/biopsy is performed. The differential diagnosis of a cystic cervical mass comprises a variety of benign conditions, but malignancy must be ruled out. We examined the diagnostic performance of fluorine-18 fluorodeoxyglucose (18F-FDG) PET/CT to identify malignancy. METHODS We retrospectively included consecutive patients referred from the Department of ENT Head and Neck Surgery for 18F-FDG PET/CT-scans because of a solitary neck cyst. Scan results were compared to histopathology and follow-up. RESULTS The study comprised 58 patients. Twenty patients (34%) were diagnosed with cancer during follow-up. PET/CT suggested malignancy in 34 patients (19 true positive, 15 false positive) and showed no malignancy in 24 (23 true negative, 1 false negative). The sensitivity, specificity, accuracy, positive and negative predictive values were 95% (76-99%), 61% (45-74%), 72% (60-82%), 56% (39-71%), and 96% (80-99%), respectively (95% confidence intervals in brackets). The primary tumor was identified in 14 out of the 20 patients with confirmed cancer. Increased metabolism, as evaluated by PET, was the only imaging characteristic among several others, which associated independently with malignancy in the cystic neck lesions, odds ratio 1.27 (1.07-1.50), p = 0.006. CONCLUSION 18F-FDG PET/CT could reliably rule out malignancy (NPV 96%), albeit with a high frequency of false positive scans, requiring further diagnostic work-up. Increased metabolism was the best imaging parameter to differentiate between malignant and benign lesions.
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Affiliation(s)
- Peymaneh Abadi
- Department of Nuclear Medicine, Odense University Hospital, Søndre Boulevard 29, 5000, Odense C, Denmark.
| | - Allan Johansen
- Department of Nuclear Medicine, Odense University Hospital, Søndre Boulevard 29, 5000, Odense C, Denmark
| | - Christian Godballe
- Department of ENT Head and Neck Surgery, Odense University Hospital, Søndre Boulevard 29, 5000, Odense C, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Søndre Boulevard 29, 5000, Odense C, Denmark
- Centre of Health Economics Research, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | | | - Anders Thomassen
- Department of Nuclear Medicine, Odense University Hospital, Søndre Boulevard 29, 5000, Odense C, Denmark
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21
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Abstract
Head and neck anatomy is topographically complex and the region is densely populated by vital nerves and vascular and lymphatic structures. Injury to many of these structures is associated with significant morbidity and may even be fatal. A thorough knowledge of regional anatomy is imperative and complications need to be managed in a thoughtful directed manner. The pediatric surgeon may be called upon to address both congenital and acquired conditions and should be prepared to encounter reoperative fields after failed initial surgery. This review summarizes the current literature on four frequently encountered surgical conditions of the head and neck: branchial cleft anomalies, thyroglossal duct cyst, thyroid disease, and lymphatic malformations, with a focus on the prevention and treatment of complications.
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Affiliation(s)
- Emily Christison-Lagay
- Department of Surgery, Yale School of Medicine, PO Box 208062, New Haven, Connecticut 06510.
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22
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Castellanos A, Scangas GA, Naunheim MR, Raol N, Cohen MS. Avoiding surgical pitfalls during resection of a "hybrid" first and second branchial cleft cyst - A case report. Int J Pediatr Otorhinolaryngol 2016; 87:91-3. [PMID: 27368450 DOI: 10.1016/j.ijporl.2016.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Angela Castellanos
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114-3096, United States; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, United States
| | - George A Scangas
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114-3096, United States; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, United States
| | - Matthew R Naunheim
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114-3096, United States; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, United States
| | - Nikhila Raol
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114-3096, United States; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, United States
| | - Michael S Cohen
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114-3096, United States; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, United States.
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Adams A, Mankad K, Offiah C, Childs L. Branchial cleft anomalies: a pictorial review of embryological development and spectrum of imaging findings. Insights Imaging 2015; 7:69-76. [PMID: 26661849 PMCID: PMC4729717 DOI: 10.1007/s13244-015-0454-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 11/25/2015] [Accepted: 11/26/2015] [Indexed: 11/27/2022] Open
Abstract
Abstract The branchial arches are the embryological precursors of the face, neck and pharynx. Anomalies of the branchial arches are the second most common congenital lesions of the head and neck in children, with second branchial arch anomalies by far the most common. Clinically, these congenital anomalies may present as cysts, sinus tracts, fistulae or cartilaginous remnants with typical clinical and radiological findings. We review the normal embryological development of the branchial arches and the anatomical structures of the head and neck that derive from each arch. The typical clinical and radiological appearances of both common and uncommon branchial arch abnormalities are discussed with an emphasis on branchial cleft anomalies. Key points • Anomalies of the branchial arches usually present as cysts, sinuses or fistulae. • Second branchial arch anomalies account for approximately 95 % of cases. • There are no pathognomonic imaging features so diagnosis depends on a high index of suspicion and knowledge of typical locations. • Persistent cysts, fistulae or recurrent localised infection may be due to branchial arch anomalies. • Surgical excision of the cyst or tract is the most common curative option.
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Affiliation(s)
- Ashok Adams
- Department of Radiology, Royal London Hospital, Barts Health NHS Trust, London, UK.
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital, Great Ormond Street, London, UK
| | - Curtis Offiah
- Department of Radiology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Lucy Childs
- Department of Radiology, Royal London Hospital, Barts Health NHS Trust, London, UK
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24
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Song CM, Ji YB, Kim KR, Tae K. Robot-assisted excision of branchial cleft cysts using a postauricular facelift approach. Auris Nasus Larynx 2015; 42:424-7. [PMID: 25863642 DOI: 10.1016/j.anl.2015.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 03/11/2015] [Accepted: 03/20/2015] [Indexed: 01/29/2023]
Abstract
Various approaches have been employed to avoid visible scars in the neck, along with the development of robotic and endoscopic techniques. We have employed a technique of robot-assisted excision of branchial cleft cyst (BCC) via a postauricular facelift approach. We present three patients with 2nd BCC who underwent robot-assisted excision of mass. All operations were performed successfully without complication. Postoperative cosmesis was excellent and all patients were satisfied with their scars which were concealed by hair and auricle. Robot-assisted excision of BCC is technically feasible and will be helpful for patients with BCC who wish to hide any visible scarring.
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Affiliation(s)
- Chang Myeon Song
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Yong Bae Ji
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Kyung Rae Kim
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Kyung Tae
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea.
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25
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Abstract
First branchial cleft anomaly is a rare disease of the head and neck. Because of its rarity, first branchial cleft anomaly is often misdiagnosed and results in inappropriate management. In this article, we present a case of type II first branchial cleft anomaly. A middle-aged woman who had suffered from swelling on lower jaw visited our department with the chief complaint of a swelling. She underwent complete excision of the lesion with preservation of the facial nerve. The patient recovered well and had no recurrence at 1-year of follow up.
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Affiliation(s)
- Surekha Chavan
- Department of Oral Pathology, Bharati Vidyapeeth University Dental College and Hospital, Pune, Maharashtra, India
| | - Revati Deshmukh
- Department of Oral Pathology, Bharati Vidyapeeth University Dental College and Hospital, Pune, Maharashtra, India
| | | | - Yeshwant Ingale
- Dr. D. Y. Patil Dental College and Hospital, Pune, Maharashtra, India
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26
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Brennan PA, Critchlow A, Rehman S, Thomas D. Spontaneous resolution of a branchial cleft cyst without intervention: a previously unreported outcome. Br J Oral Maxillofac Surg 2014; 52:379-81. [PMID: 24613266 DOI: 10.1016/j.bjoms.2014.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 02/05/2014] [Indexed: 11/23/2022]
Abstract
Branchial cleft cysts typically present as a persistent mass in the anterior triangle of the neck. Diagnosis is made by imaging and fine needle aspiration cytology and is confirmed histologically after excision. We report a branchial cleft cyst in a 27-year-old woman that resolved spontaneously over several weeks without surgical intervention. To the best of our knowledge this is the first report of such a case.
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