Diagnosis and treatment of branchial cleft anomalies in UKMMC: a 10-year retrospective study

Abstract

Branchial cleft anomalies result from abnormal persistence of branchial apparatus, which is located at the lateral part of the neck. These occur due to failure of obliteration of the branchial apparatus during embryonic development. Differential diagnoses of lateral neck mass are salivary gland or neurogenic neoplasms, paragangliomas, adenopathies, cystic hygroma or cystic metastasis from squamous cell carcinoma or thyroid papillary carcinoma. Clinically, a branchial cyst is smooth, round, fluctuant and non-tender, and usually occurs over the upper part of the neck, anterior to the sternocleidomastoid muscle. Sometimes, it may present as infected cyst (or abscess), a sinus or fistula. Surgical excision is the definitive treatment for branchial anomalies. The objective of the work was to study the demographic data, clinical presentation, definite diagnostic workup and treatment of patients diagnosed with branchial anomalies. This is a retrospective study of 26 patients who were diagnosed with branchial anomalies (branchial cyst and fistula), of which only 12 patients had data available between July 1999 and June 2009 at the Otorhinolaryngology, Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre. Twelve cases of branchial anomalies were seen, in which 10 patients had second branchial cyst anomalies, 1 had third branchial fistula and 1 had bilateral branchial lesion. There were seven females and five males. The age of the patients varied over a wide range (4-44 years), but the majority of the patients were in their second and third decade of life. All branchial anomalies occurred at the classical site; eight patients had left-sided neck lesion. Correct clinical diagnosis was made only in five patients (41.6 %). All patients underwent surgical excision with no reported recurrence. Branchial anomalies are frequently forgotten in the differential diagnosis of lateral neck swelling. Diagnosis is usually delayed, leading to improper treatment. The diagnosis of patients who present with lateral neck cystic swelling with or without episodes of recurrent neck abscess should be considered with a high suspicion for branchial anomalies. FNA cytology is a good investigative tool in reaching toward a diagnosis of branchial lesion, with the concurrent assistance of radiological modalities. Surgical excision is the gold standard treatment of lesions of branchial anomalies.

Thyroid Papillary Carcinoma in a Branchial Cleft Cyst—A Case Report

“…Thyroid scintigraphy (with technetium-99) is very useful in diagnosis, especially in case of ectopic thyroid tissue. FNA cytology examination, plus thorough endoscopy of the upper respiratory system should be performed, for exclusion of metastatic or inflammatory adenopathy [3].…”

“…Branchial cysts are the result of branchial apparatus obliteration failure during the first stage of embryonic life and originate from the second (95%), the first (8% -10%), the third (2% -8%) and the fourth (1% -2%) branchial remnant [3].…”

“…Males and females are equally affected and there is occasionally a hereditary tendency. Twenty to 40% of patients report branchial cyst manifestation after an attack of pharyngitis, ear or dental infection, and many report temporary enlargement with or without tenderness during periods of upper respiratory tract infection [3]. Branchial cysts walls are thin and lined by squamous stratified epithelium overlying lymphoid tissue.…”

Second Branchial Anomalies in Children and Literature Review

“…Post-operative complications include cranial nerves injury(3.5%), damage to internal jugular vein, formation of persistent fistula, local infection, seroma, hematoma or scar formation(3.3%) (11,19). The overall recurrence rates following surgery were 3-4.9% in retrospective studies of 98 and 183 patients (3,11).However, the recurrence rate may be as high as 22% if there is a history of infections or incomplete operation (20).…”

Branchial cleft and pouch anomalies in childhood: a report of 50 surgical cases

“…Branchial cysts have no external or visceral opening and thus retain secretions, while branchial sinuses are blind ending tract communicating with the skin or the pharyngeal lumen; finally, fistulas are tracts connecting the pharynx to the skin [8,10]. Branchial cyst was first described by Ascherson in 1832, who suggested that this resulted from the impaired obliteration of the branchial cleft or pouches; these are the most common congenital masses of the lateral neck and they represent 20-80 % of the branchial anomalies [11,12].…”