First Branchial Cleft Anomalies: Awareness Is Key

Abstract

Two patients presented with fluctuant areas inferior to the pinna. The first required numerous procedures and investigations before a correct diagnosis was obtained. However, with awareness of this condition, the subsequent patient was quickly identified and managed appropriately. First branchial cleft abnormalities are uncommon, however, present with common symptoms. Their location and characteristics in paediatric patients is key to having it in the differential diagnosis. Consideration of this condition by ENT surgeons is key to prevent multiple invasive and futile operations in our paediatric cohort.

Postauricular Cyst in a 15-Year-Old Girl

“…2 Branchial cleft anomaly commonly affects female patients and the left side of the head and neck. 2,3 First BCA can present as either a cyst, sinus, or fistula in the Poncet triangle, which has its apex at the EAC and base between the chin and midpoint of the hyoid bone, with chronic or recurrent upper neck infections. 3 First BCA was divided into types 1 and 2 by the Work classification system in 1972.…”

“…2,3 First BCA can present as either a cyst, sinus, or fistula in the Poncet triangle, which has its apex at the EAC and base between the chin and midpoint of the hyoid bone, with chronic or recurrent upper neck infections. 3 First BCA was divided into types 1 and 2 by the Work classification system in 1972. [2][3][4][5] Type 1 anomaly is usually discovered in very young children as a thin-walled, soft mass located medially, inferiorly, or posteriorly to the pinna and superficial to the facial nerve.…”

“…3 First BCA was divided into types 1 and 2 by the Work classification system in 1972. [2][3][4][5] Type 1 anomaly is usually discovered in very young children as a thin-walled, soft mass located medially, inferiorly, or posteriorly to the pinna and superficial to the facial nerve. 2,4 Type 2 anomaly is usually discovered at a later age as a fistulous opening within the Poncet triangle.…”

“…4 For BCA, MRI is a useful diagnostic modality to identify the extent of the lesion, the relationship with the facial nerve, and the risk of facial nerve damage for operative planning. 3 Branchial cleft cyst reveals high signal on T2-weighted imaging. 5,6 However, T1weighted imaging can show diversity due to variation in proteinaceous contents, 6 with high signal intensity with high protein content of mucus within the BCA.…”

“…The treatment of first BCA is complete surgical excision to prevent recurrence. [2][3][4][5] Definitive diagnosis is possible on histopathologic examination after surgical excision. 1 Histopathologically, branchial cleft cysts are usually lined with squamous epithelium and may show concentrations of lymphoid tissue.…”