Scarless Excision of Second Branchial Cleft Cyst via Retroauricular Hairline Incision

BACKGROUND

Second branchial cleft cyst (2nd BCC) is treated by complete excision. Conventional transcervical skin incision on the lesion may leave a prominent scar in the cosmetically sensitive area. The retroauricular hairline incision (RAHI) approach may maintain neurological, mobility, and cosmetic functions of the neck and face after excision. This study evaluated the clinical outcomes and disease control of scarless surgery via RAHI in 57 consecutive patients with 2nd BCC.

METHODS

The patients received the prospective evaluation of postoperative neurological, subjective pain, swallowing, neck motion, and cosmetic functions. Postoperative complications, subjective satisfaction, and recurrence were also assessed in each patient.

RESULTS

Excision was performed in all cases without injury to the facial nerve or other neurological complications and conversion to other incisions or approaches with a median operation time of 44 min. Complications were minimal, without dysphagia, neurological deficits, or limited neck motion. Postoperative incision scars in the postauricular and hairline region were commonly invisible. Subjective satisfaction with the scar and facial deformity was high after surgery. No patients had a recurrence for a median follow-up of 66 months.

CONCLUSION

The RAHI approach for 2nd BCC has excellent cosmetic, functional, and disease control outcomes. This can be safely applied to the treatment of 2nd BCC.

LEVEL OF EVIDENCE IV

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Huge second branchial cleft cyst: A case report

INTRODUCTION AND IMPORTANCE

Second branchial cysts are benign dysembryological cystic tumors that develop in the antero-lateral part of the neck. They represent 2 % of laterocervical tumors of the neck and are usually diagnosed before adulthood. The cysts can increase in size and cause multiple complications. Ultrasound and MRI (Magnetic Resonance Imaging) confirm their cystic nature. Treatment consists of surgical excision.

CASE PRESENTATION

We report the case of a 31-year-old woman who presented with a left laterocervical swelling measuring 8 cm, which had been present for 18 months without any other associated symptoms. An exploratory cervicotomy was performed, and the histological diagnosis was a second branchial cleft cyst without signs of malignancy.

CLINICAL DISCUSSION

The definitive diagnosis of a second branchial cleft cyst is confirmed by anatomopathological examination. Therapeutic management is always surgical and should be performed as early as possible to limit the risk of complications.

CONCLUSION

Second branchial cleft cysts are relatively uncommon malformations. Diagnosis is suspected based on physical examination, guided by imaging data, and confirmed by anatomopathological examination. Treatment is surgical, with complete removal of the cyst being necessary to prevent recurrence.

CT and MR imaging findings of infection-free and benign second branchial cleft cysts

PURPOSE

The present study aimed to assess CT and MR imaging findings of infection-free and benign second branchial cleft cysts (SBCCs).

METHODS

Eleven patients with histopathologically confirmed infection-free and benign SBCCs underwent preoperative contrast-enhanced CT (CECT) and/or MR imaging. We assessed qualitative (presence and extent of wall thickening, degree of contrast enhancement of the thickened wall on CECT images, and signal intensity of the thickened wall on T2-weighted images) and quantitative (maximum thickness of the thickened wall) imaging findings.

RESULTS

Eccentric and smooth wall thickening was observed in 11/11 (100%) patients. The wall thickening extent (percentage of the thickened wall to the circumference of the wall) was small (1%-25%) in 4/11 (36%), moderate (26%-50%) in 6/11 (54%), extensive (51%-75%) in 1/11 (9%), and diffuse (76%-100%) in 0/11 (0%) patients. Mild homogeneous enhancement of the thickened wall on CECT images was observed in 7/7 (100%) patients. The signal intensity of the thickened wall on T2-weighted images was isointense relative to that of normal lymph nodes in 7/8 (88%) and mildly hyperintense in 1/8 (12%) patient. The maximum thickness of the thickened walls ranged from 2 to 4 (mean 3.4) mm.

CONCLUSIONS

Infection-free and benign SBCCs are identifiable as cysts with eccentric and smooth wall thickening on CECT and MR images. The wall thickness was almost always less than half of the wall circumference, isointense relative to normal lymph nodes, and showed mild homogeneous enhancement.

Branchial cleft cyst

Branchial cleft cysts are benign lesions caused by anomalous development of the brachial cleft. This report describes a 20-year-old girl with swelling on the right lateral aspect of the neck, which expanded slowly but progressively. The clinical suspicion was that of a branchial cleft cyst. Sonography revealed a homogeneously hypo- to anechoic mass with well-defined margins and no intralesional septa. Color Doppler reviewed no internal vascularization. The ultrasound examination confirmed the clinical diagnosis of a second branchial cleft cyst, demonstrating the cystic nature of the mass and excluding the presence of complications. For superficial lesions like these, ultrasound is the first-level imaging study of choice because it is non-invasive, rapid, low-cost, and does not involve exposure to ionizing radiation.