Isolated facial pain as the sole presentation of a type I branchial cleft cyst in an adult male.

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A Second Branchial Cleft Cyst Presenting as a Dumbbell -Shaped Anterior Neck Mass

<p>Branchial cleft anomalies comprise approximately 30% of congenital neck mass and present as cyst, sinus or fistula. They occur due to disturbance in the maturation of the branchial apparatus during fetal development. They are congenital lesions usually present in childhood, but they are usually diagnosed in later childhood or early adulthood because of enlargement or infection. Branchial cleft fistulae are usually diagnosed earlier than cysts. Correct diagnosis leads to proper management. Complete surgical excision is the treatment of choice. Second branchial cleft and pouch anomalies are commonest amongst all branchial cleft lesions, but complete second branchial cleft anomalies with external and internal opening is rare. Branchial anomalies with family history are also very rare. Here we present a case report of complete branchial fistula with family history which was managed by complete excision of fistula through transcervical and transoral approaches. 3 members of one family in 2 generations presented with branchial apparatus anomalies (father and his two children, elder son and younger daughter). All of them were having branchial fistula on right side of neck since birth.</p>

Introduction Branchial cleft anomalies are the second most common congenital anomaly in children. However, some lesions may not develop clinically and are not diagnosed until adulthood. The recent literature of branchial cysts (BCs) in the adult population is really scanty. For this reason, we analyzed the clinical and surgical management of the adult population treated for a BC at a tertiary care general hospital. Methods A retrospective review of the clinical records of all the patients with histological diagnosis of BC who were surgically treated at the Social Security Hospital in Quito, Ecuador, was performed. Fifty-one patients (27 women) with congenital anomalies of the 2 nd (43 patients with cysts) and 3 rd (6 patients with cysts and 2 with fistula) branchial arches were diagnosed and treated. Diagnosis was made on clinical grounds and by computed tomography scan. Results The 43 patients with a 2 nd branchial cleft cyst underwent complete surgical excision through a wide mid-neck transverse cervicotomy. The 6 cases of 3 rd branchial cleft cyst underwent surgical resection through a lower-neck transverse incision, and the 2 patients with clinical fistula in the lower aspect of the neck were operated on via an elliptical incision around this external fistula opening. Postoperative evolution was uneventful in all patients. Conclusions Branchial cysts can occasionally be diagnosed in adult patients in the setting of a general hospital population. A correct clinical and imaging assessment was diagnostic in most patients. Complete surgical resection was curative in all our patients, and postoperative complications were exceptional.

Branchial cleft or cervical lymphoepithelial cysts: Etiology and management

BackgroundFirst branchial cleft anomalies are rare, accounting for only 10% of all branchial cleft anomalies. We report an even more rare and unique case of a branchial cleft cyst with features of both first and second arch derivatives.Case presentationA 6-year-old boy presented to us with a left conductive hearing loss associated with pre-tympanic keratin debris and an ipsilateral painful cervical mass. He had a past medical history of left ear surgery for presumed cholesteatoma 2 years prior and left neck abscess drainage 6 months prior. CT and MRI revealed a lesion originating in the external auditory canal and extending cervically through a bony canal located medial to the facial nerve and terminating as a parapharyngeal cyst. The complete removal was accomplished in one surgical stage consisting of three distinct steps: robotic assisted transoral resection of the pharyngeal cyst, an endaural approach and a parotidectomy approach.ConclusionWe believe that our detailed description of this rare first branchial cleft cyst with pharyngeal extension, possibly a hybrid case between a first and second branchial cyst, can serve as a valuable tool to Otolaryngologists – Head and Neck Surgeons who come across a similar unusual presentations.

The ultrasonic diagnosis of cervical and facial cystic masses, as well as cases of missed diagnosis and misdiagnosis, was examined, to improve the diagnosis of branchial cleft anomalies. A retrospective analysis was conducted on 17 patients with branchial cleft cyst anomalies, including 11 males and 6 females, aged 12-53years, with an average age of 33 ± 2years, were unilateral single. All patients who underwent an ultrasound examination and image storage for retrospective analysis, and both longitudinal and transverse sections were scanned to observe the shape, size, boundary, peripheral relationship, and blood flow signal of the masses. All cases were examined with an enhanced CT scan, and pathological reports were generated. Among the 17 cases of branchial cleft anomalies, 15 cases were branchial cleft cysts, while one case involved fistula formation and one case involved sinus tract formation. Based on the type of branchial cleft, the first, second, and third cysts were classified in 4, 12, and 1 case, respectively. The sensitivity rate and specificity of ultrasonic diagnosis were 14/17 (82.4%) and 4/6 (66.7%), respectively. Ultrasonic characteristic analysis for the masses can be found in simple cystic masses or hypoechoic masses, most of them are of a regular shape and have a distinct boundary, and almost no blood flow signal. All patients who were misdiagnosed exhibited blood flow signals, including 1 patient with an abundant blood flow signal, 1 patient suspected of having ectopic thyroid with an abnormal function due to the rat-tail sign, 2 patients misdiagnosed as local inflammatory focus, and 1 patient misdiagnosed with tuberculous lymphadenitis. Ultrasound has a detection rate of up to 100% for cervical and facial masses, providing a fundamental determination of lesion characteristics and specific guidance for preoperative diagnosis. If the blood flow signals can be identified and carefully considered their peripheral relationship, the diagnostic rate can be improved.

Type 2 branchial cleft anomalies are the most common cause of lateral neck swelling. We report two cases of type 2 branchial cleft anomalies. The first case is branchial cleft cyst and the second one is branchial fistula. Both cases were managed surgically. The post operative outcomes were uneventful. Second branchial cleft anomalies are the most common branchial anomalies. Branchial cysts are more common than sinuses and branchial fistulae are extremely rare. There is no gender predilection. The location, clinical symptoms and imaging findings aid in the diagnosis of this condition. Surgical excision is the mainstay of treatment.Keywords: branchial cleft; branchial cyst; branchial fistula.

Branchial abnormalities occur when there is disturbance in the maturation of the branchial apparatus during fetal development. Branchial anomalies are congenital lesions usually present in childhood, even if they can be diagnosed later for enlargement or infection. A correct diagnosis will lead to proper management: complete surgical excision is the treatment of choice. The purpose of this article is to present clinical features, diagnostic methods and surgical treatment of branchial anomalies in childhood, based on a series of 50 patients. We conducted a retrospective analysis of a total of 50 pediatric patients operated from June 2005 to June 2014 for the presence of branchial cleft anomalies. 27 cases (54 %) presented a second branchial cleft fistula and 11 cases (22 %) a second branchial cleft cyst and one case (2 %) presented both cyst and sinus of the second branchial cleft; four cases (8 %) presented first branchial cleft cyst whereas four cases (8 %) a first branchial cleft sinus and two cases (4 %) a first branchial cleft fistula; one case (2 %) presented a piriform sinus fistula (third branchial cleft). None of our patients presented anomalies of the fourth branchial cleft. All patients underwent surgical treatment and lesions have been removed by excision or fistulectomy. No post-surgical complication occurred. The rate of recurrence was 4 %. Pre-operative diagnosis supplies important information to the surgeon for a proper therapy: a complete excision of the lesion without inflammatory signs is essential to avoid re-intervention and to achieve a good outcome.

Branchial cleft anomalies may be presented as branchial cysts, fistulas, or sinuses. Purpose of this paper is to present the diagnostic procedures and the treatment in a series of branchial cleft cysts. Eighteen patients with branchial cleft cysts were surgically treated. All of them were subjected in laboratory examinations with ultrasonography, CT or/and MRI, and fine needle aspiration cytology (FNAC). Complete excision was the treatment in all cases. Eight patients had Type I, seven Type II, two Type III, and one a Type IV cyst. In all cases the surgical removal was successful and after 1 to 7 years post-surgical follow-up, no recurrences have been developed. Branchial cleft cyst diagnostic procedure must be the same as for other neck swellings. FNAC is very useful for the diagnosis and the surgical approach must ensure safe and complete cyst removal in order to avoid intraoperative complications and recurrences.

The term "branchial cleft cyst" refers to the lesions that can be considered synonymous with cervical lymphoepithelial cysts. Although relatively rare, they constitute the second major cause of head and neck pathologies in childhood. This study aimed to report the clinical presentations, diagnosis, and management of pediatric patients with the pathological diagnosis of branchial cleft cyst. This study was a retrospective analysis of the records of 33 patients with the diagnosis of branchial cyst, in two different university hospitals, in two different populations. Thirty-three cases of branchial cleft cysts were seen in 33 patients: 17 females and 16 males. The majority (16 patients) were 2nd branchial cleft cysts. Accurate diagnosis of branchial cleft malformation was made via imaging in 20 of the 21 (95%) patients that underwent preoperative surgical ultrasonographic imaging. Branchial cleft cysts are frequently incorrectly diagnosed and ignored in the differential diagnosis. Thus, the diagnosis is often delayed, resulting in the mismanagement of affected patients. A branchial cyst should be suspected in any patient with a swelling in the lateral aspect of the neck, regardless of whether the swelling is solid or cystic, painful or painless. The use of ultrasonography can dramatically help clinicians with distinguishing branchial cleft cysts from other similar lesions of the head and neck.

Background: First branchial cleft anomaly exhibits variable clinical features, ranging from a painless swelling, discharging sinus or pit, to recurrent infection. It could be easily misdiagnosed and mismanaged, resulting in recurrence. Hence, any swellings or pits in Poncet’s triangle with a history of recurrent infection should raise the suspicion of a first branchial cleft anomaly. Objective: To present a case of chronic non-healing wound caused by an incompletely excised first branchial cleft anomaly. Methods: Case observation of a patient with a history of incomplete excision of a first branchial cyst. Results: Our patient was a case of incompletely excised first branchial cyst which subsequently presented as a chronic non- healing wound. She had undergone several workup for non-healing wound resulting in delay in receiving definitive treatment. Conclusion: Early recognition of first branchial cleft anomalies is important to prevent chronic complications and mismanagement.

Branchial cysts are remnants of embryonic development and result from a failure of obliteration of the branchial clefts. They are a common cause of a congenital mass of the neck and an estimated 2–3 % of cases are bilateral. Branchial cysts are congenital cysts, which arise on the lateral aspect of the neck and commonly due to failure of obliteration of the second branchial cleft in embryonic development. Untreated branchial cleft cysts are prone to recurrent infection and abscess formation with resultant scar and sinus formation. There are rare case reports of malignancies that have been identified in branchial cleft lesions, including branchiogenic carcinoma and papillary thyroid carcinoma.

Branchial Cleft (Pouch) Anomalies: A Review of 42 Cases

Type II first branchial cyst and sinus excision with preservation of facial nerve and parotid gland