The treatment for the first branchial cleft anomalies in children

Abstract

The objective of this study is to make a clinical analysis for first branchial cleft anomalies (FBCAs), especially introduce the relationship between the Type I/II FBCA with the facial nerve and to demonstrate the importance of using intraoperative microscope and facial nerve monitoring. This is a retrospective review of patients with FBCAs treated in Beijing Children's Hospital, from Jan 2013 to Dec 2015. Clinical data of patients, including sex, age, chief complains, history of surgery, incision and drainage, the relationship with the facial nerve, pre and post-operative facial paralysis, recurrent rate and complications were recorded. FBCAs were divided into two subtypes according to Work's Classification. All patients had an MRI examination for diagnosis and to locate the lesions before surgery. Both microscope and facial nerve monitors were routinely used for detecting and protecting the facial nerve. The study cohort included 42 patients with ages ranging from 10 months to 14 years. The chief complaint was recurrent swelling or abscess near the ear or angle of mandibular. 76.2% of them (32/42) had incision and drainage histories. Two of them had suffered from facial palsy during the infectious period. Seven patients had undergone surgeries once or twice in other hospitals. Four patients with Type II FBCAs developed temporary facial palsy. We had follow-ups for each patient from 3 months to 3 years. 4 (9.5%) patients with Type I FBCA had got postoperative external auditory canal (EAC) stenosis. There were no cases of recurrence. Type II FBCAs has closer relationship with facial nerve than Type I FBCAs. The facial nerve of Type II FBCAs may lie more superficially and ascending to the fistula. Intraoperative microscope and facial nerve monitoring were necessary for protecting the facial nerve and decreasing the recurrent rate.

Clinical analysis of first branchial cleft anomalies in children

“…Solares et al considered that successful treatment of FBCA requires complete resection and stated that complete resection requires full exposure of the facial nerve. We recommend making the incision as described by Zhang and Ni et al instead of the traditional “S” or “Y” shaped incision. For type I FBCAs in the present study, a fusiform incision was made, including the infected area in the post‐aurum.…”

Clinical Analysis of Type II First Branchial Cleft Anomalies in Children

“…Previous authors have suggested that type II FBCAs exhibit a closer relationship with the facial nerve than type I FBCAs. 6,7 Type II FBCAs are located from the earlobe to the upper neck, but not all type II FBCAs adhere to the facial nerve. In the present study, we divided type II FBCAs into three subtypes based on MRI findings.…”

“…Such complications include both temporary and permanent facial nerve palsy. Zhang et al 6 confirmed a close relationship between type II FBCAs and the facial nerve, especially when the fistula opening is located below the mandibular angle. In these patients, the facial nerve may lie more superficially and ascend toward the fistula.…”

Type II First Branchial Cleft Cyst Presenting as Parotid Mass: A Case Report

“…FBCAs are difficult to surgically resect due to their close association with the facial nerve. Complications can include facial nerve palsy/injury, parotid seroma, EAC stenosis [4]. Due to the close association of the facial nerve with type II lesions, it is recommended to have an operative microscope or telescope to avoid injury to the nerve, as well as contrast-enhanced preoperative imaging and intraoperative facial nerve monitoring.…”

“…Due to the close association of the facial nerve with type II lesions, it is recommended to have an operative microscope or telescope to avoid injury to the nerve, as well as contrast-enhanced preoperative imaging and intraoperative facial nerve monitoring. In fact, some surgeons in still a water-soluble dye such as methylene blue intraoperatively to help define the anomalous tract [4].…”