Congenital branchiogenic anomalies: A report of 82 cases

Abstract

The embryology of the branchial system of arches, pouches and clefts is briefly reviewed. From a correlation of embryologic facts and clinical findings in cases of lateral fistulae and cysts of the neck it is believed that these lesions develop most commonly from the second branchial cleft and branchial pouch. The congenital sinuses of the ear and preauricular region are believed to develop from an incomplete fusion of the lobules which normally coalesce to form the ear. Lateral, cartilaginous pedunculated or sessile tabs of the neck would appear to represent anomalous formations from the second or third branchial arch. The symptoms of auricular or lateral cervical sinuses are referable to: (1) discharge of mucoid material originating in the lining membrane; (2) discharge of desquamated cells from the lining epithelium if this be of the squamous type; or (3) recurring local inflammation. The lateral congenital cysts of the neck may be troublesome because of local swelling, of recurring infection, or because of reflex disturbances by pressure on the vagus nerve. The cartilaginous rests of the neck are important only from the point of view of cosmetic disfigurement. The small auricular and preauricular sinuses can be treated by injection of sclerosing fluids or by endothermy coagulation. When there has been recurrent infection in a preauricular sinus with consequent destruction of subcutaneous tissue, the lesion is best treated by excision. If a cervical fistula is small and has little discharge, no treatment is necessary, but if the discharge is bothersome, or if there has been repeated infection, the entire tract should be excised. A lateral cervical cyst should be excised, and any tract communicating with it should also be removed. The operative incision for the neck lesions should never be parallel to the sternocleidomastoid muscle, but should always be made in the direction of the neck folds. In those cases in which extensive dissection of the neck is necessary, adequate exposure can be obtained by the use of two horizontal incisions placed in a stair step fashion. When such incisions are carefully closed and the skin edges are approximated with continuous subcuticular sutures, the resulting scars are minimal and are almost invisible.