First branchial cleft cysts: Clinical update

Abstract

First branchial cleft cysts develop as a result of incomplete fusion of the cleft between the first and second branchial arches and give rise to two distinct anomalies, termed type I and type II anomalies. Type I anomalies are purely ectodermal while type II anomalies exhibit ectodermal and mesodermal elements. The type II anomaly incorporates some portion of the first and second arch as well as the cleft. Type I lesions are extremely rare. They appear histologically as cysts lined by squamous epithelium. Clinically, they present as a cystic mass or fistula posterior to the pinna and concha. The cyst is usually superior to the main trunk of the facial nerve and ends in a cul-de-sac on or near a bony plate at the level of the mesotympanum. Type II lesions are more numerous and represent a duplication of both membranous and cartilaginous portions of the external auditory canal. They contain skin as well as adnexal structures and cartilage and may be associated with the parotid gland. Most frequently they are associated with fistulae in the concha or external auditory canal as well as fistulous openings in the neck.

Clinical and microbiological differences between pyriform sinus fistulae in pediatric and non-pediatric patients

“…Third and fourth branchial arch anomalies have been considered very rare embryological conditions, making up less than 1% of all brachial anomalies [8,9]. However, in recent years, there has been an increase in the number of reports of acute suppurative thyroiditis or perithyroidal inflammation caused by branchial anomalies with PSF.…”

Unusual association of congenital middle ear cholesteatoma and first branchial cleft anomaly: management and embryological concepts

“…A fifth one appears but quickly regresses. Each merged arch Association of congenital middle ear cholesteatoma and first branchial cleft 281 gives rise to a bone and cartilage derivate, one or more striated muscles, a mixed cranial nerve and a vascular component [2,3]. To our knowledge, associations between middle ear congenital cholesteatoma and first branchial cleft anomalies had never been described in the literature.…”

Periauricular Cysts and Sinuses

“…Intravenous antibiotics should be given for infections unresponsive to oral antibiotics. Infected lesions may need to be incised and drained before definitive therapy 12 . Young age may be a consideration delaying surgery, but earlier intervention is optimal for surgery.…”

“…In special situations, a more limited excision can be performed by marsupializing the congenital remnant. A duplication anomaly within the ear canal can be marsupialized by excising the common wall, resulting in the branchial remnant forming part of the new canal 12 . Work 4 advocated marsupialization of the external auditory canal but as an added precaution to prevent recurrences.…”