Multidetector computerized tomographic fistulography in the evaluation of congenital branchial cleft fistulae and sinuses

Two patients (a 58-year-old man and a 58-year-old woman) had branchial cysts in the parotid gland, and the other patients had one in the submandibular gland. Branchial cysts usually occur in the lateral cervical area and are rare in salivary glands. Branchial cysts in salivary glands are classified as first branchial cleft cyst and second branchial cleft cyst depending on the site of origin.First branchial cleft cysts are rarer than second branchial cleft cysts and usually appear in the preauricular area. The cysts are lined with stratified squamous epithelium, and scant lymphoid tissue is seen in the subepithelial area. Second branchial cleft cysts usually occur in the lower portion or superficial lobe of a parotid gland. They are lined with stratified squamous epithelium plus columnar or cuboidal epithelium. Beneath which is abundant lymphoid tissue with clear lymphoid follicles. Clinical and pathological examinations showed that the two parotid gland cysts were probably second branchial cleft cysts and the one in the submandibular gland was probably a first branchial cleft cyst.

Images in emergency medicine

Second branchial anomalies like branchial cyst, sinus or fistula are common lateral neck masses in pediatric age group but it is rare to encounter complete branchial fistula with external as well as internal openings. We present a case of 16 yrs old female patient with complete Branchial fistula which was diagnosed with the help of CT fistulogram and thereafter taken up for surgical excision of fistula under general anaesthesia. Histopathology confirmed the diagnosis of branchial fistula. In case of lateral neck mass with external opening in pediatric age group strong possibility of diagnosis of branchial fistula should be kept, timely management of the case improves the quality of life.

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

Branchial apparatus was first described by Von Baer, but Von Ascheron was the one who described the anomalies in its development. The branchial cyst, sinus and fistula are anomalies of the branchial apparatus which consists of five mesodermal arches separated by invagination of ectoderm (clefts) and endoderm (pouch). Here we present a case of bilobulated second branchial fistula which had both openings over the skin of right anterolateral aspect of the neck. A seven years old girl, presented to ENT OPD, complaining of swelling on right side of the neck associated with discharge from an opening over the swelling since birth. The swelling was painless, progressively increasing in size. Her mother revealed that she had occasionally had a clear discharge from the openings since birth. On examination, dumbbell shaped cystic swelling approx. 5×2 cm in size with two pinhead openings on both the ends, noticed along the anterior border of SCM over the middle third of the neck. Radiological and histopathological investigations confirmed the diagnosis of second branchial fistula. Patient was managed with complete surgical excision. Second branchial anomalies present along the anterior border of sternocleidomastoid. Fistulous tract commonly extends into the pharynx, most commonly in the region of tonsillar fossa. This case report describes a congenital anomaly for which the definitive treatment was surgery. Unlike, other complete second branchial fistula it had two external openings and it was a bilobulated tract, which makes this case a rare variety of branchial fistula

Objective: To provide the experience of diagnosis and treatment of second branchial cleft fistula in children. Methods: The clinical data of 76 children with second branchial cleft fistulas admitted to Beijing Children's Hospital affiliated with Capital Medical University from January 2016 to December 2020 were retrospectively analyzed. All patients underwent cervical ultrasonography and resection of the second branchial cleft fistula, and their clinical manifestations, surgical methods, complications, recurrence condition, and lesion appearance of the patients were analyzed. Results: Among the 76 cases, the lesions of 43 cases were on the right side, 20 were on the left side, and 13 were bilateral, for a total of 89 lesions. There were 49 type I lesions, 28 type II lesions, 8 type III lesions, and 4 type IV lesions. Type I and type II cases underwent complete excision of the fistula through a small incision in the neck; 2 cases of type III branchial cleft fistulas were treated with trapezoidal incision; 2 cases of type III branchial cleft fistulas underwent single transverse incisions; single small incision-assisted endoscopic resection was adopted in 4 cases of type III and 4 cases of type IV branchial cleft fistulas. During the follow-up period of 6 to 60 months, only 3 cases developed postoperative infection, the others had no postoperative complications, and no cases had recurrence during postoperative follow-up. Conclusion: The incision of the second branchial fistula should be selected according to imaging examination to achieve removal of the fistula while maintaining esthetics.

INTRODUCTION: Most of the branchial cysts (>90%) come from the second branchial arch. These are originated from an embryonic defect consisting of the lack of fusion between de second branchial arch and the basal portion of the fourth cleft, causing the interiorization of the ectodermic tissue of the laterocervical area. The cyst and the fistula may sometimes go from the medium area of the sternocleidomastoid (SCM) muscle to the tonsillar region. Rarely, they appear in the childhood and they are usually asymptomatic. Only if the cyst is infected, the patient consults about the appearance of a laterocervical tumor. Surgery is the treatment of this disease when symptomatic by removing the cyst and its fistulae, if it exists. METHODS: A 52-year-old patient goes to Emergency department to discard the presence of a left peritonsillar abscess. The patient doesn’t report odynophagia, dysphagia, trismus nor fever. The only symptom he reports is dyspnea in supine decubitus. When he is checked, a great bulging of the anterior tonsillar pillar is seen, blocking nearly all the oropharyngeal space and moving the uvula to the right. An aspiration-puncture is made without purulence drainage. When an endoscopy is made, the hypopharynx and larynx are medializated. A CT scan shows the presence of a left parapharyngeal cystic mass, with a 5.1x2.5cm diameter, surrounded by a thin wall that captures contrast. It is located medially to de SCM muscle and between the internal and external left carotids, blocking the airway. This tumor is suitable for a second cleft branchial cyst. An elective surgery is decided, performing a left cervicotomy to partially remove and marsupialize the cyst. Nowadays, the patient has a left Horner syndrome because of the handling of the carotid during the surgery. CONCLUSIONS: The second branchial arch cysts are the most frequent branchial cysts. When a peritonsillar abscess is suspected and no typical symptoms are featured, a second branchial cyst may be included in the differential diagnosis. The use of images is very important to confirm the diagnosis and acknowledge the patient’s anatomy in order to prepare a surgery.

Lymphoepithelial cyst of the parotid gland--a case report.

A complete second branchial fistula is very rare and has an internal opening at the tonsillar fossa and an external opening at the lower third of the sternocleidomastoid (SCM). Patients commonly present with persistent or intermittent mucoid or mucopurulent discharge from an external opening. The diagnosis is most often clinical and radiological investigations are rarely needed. Treatment of choice is complete surgical excision. The aim of this article is to aware young ENT surgeons of the various clinical and intraoperative surgical findings that can be encountered while dealing with these cases. This observational study was done for a period of 10years. A total of 20 cases of fistula were included which intraoperatively had a complete track from tonsillar fossa to neck. Excision of the tract was carried out via combined transcervical and transoral approach under general anaesthesia using two incisions in stepladder pattern. Each patient was seen after one year of surgery to assess for any recurrence. Different findings of patients including age/sex at surgery, initial presentation, family history, laterality of the fistula tract, Intraoperative surgical findings, complications, and recurrences. were noted. Of the 20 patients, 13 (65%) were females and 7 (35%) were Females. Most common complaint was fistulous opening with intermittent discharge(15patients; 75%).Branchial cleft fistulae more commonly affected the right neck (14 patients, 78%) among unilateral cases and 2 patients (10%) had bilateral fistulae. No patient had associated congenital anomaly/syndrome, family history or and visible opening in tonsillar area. Glossopharyngeal nerve was identified in 12 cases and track was seen passing lateral to it except in one case. The internal opening of track was seen over posterior tonsillar pillar in 15 cases (75%) while in 5 patient the track was seen entering tonsillar tissue or bed. Tonsillectomy was done in 5 cases while not done in 15 cases where track was seen entering posterior pillar. All patients were seen at one year follow up. No recurrence was seen at one year of follow up. Complete second branchial cleft fistulae are rare. They are usually right sided and unilateral. The track passes between carotid bifurcation and invariably passes lateral to both glossopharyngeal and hypoglossal nerves. Track usually ends at the posterior tonsillar pillar. Tonsillectomy is not routinely indicated. Recurrences are not typically seen.

<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>

Lateral cervical cystic masses are a relatively common occurrence in the otolaryngology practice, which are often attributed to second branchial cleft cysts. However, there should always be a high suspicion for malignancy until proven otherwise. We present a clinical report of a lateral cervical cyst surgical excision where histopathological examination has revealed features of a branchial cleft cyst harboring a papillary thyroid carcinoma. This led to the clinically latent thyroid primary which was treated through thyroidectomy with selective neck dissection and radioactive iodine therapy. Across current literature regarding thyroid carcinomas arising within branchial cysts, primary thyroid carcinoma was identified in almost half the cases where thyroidectomy was performed. There is no established consensus on the decision of whether to perform a thyroidectomy in such cases, due to the paucity of data for similar cases. Although branchial cyst is a benign condition, it can harbor malignancy. When thyroid carcinoma occurs within such a cyst, without solid evidence of a thyroid primary, treating physicians are presented with a diagnostic and treatment dilemma. As more cases are discovered and reported, navigating this challenging dilemma will become clearer for the treating physicians.

Lymphoepithelial (so-called branchial) cyst within the parotid gland. Report of a case and review of the literature

Diagnosis and treatment of branchial cleft cysts and fistulae. A retrospective study of 183 patients

Differential diagnosis between thymic duct fistulas and branchial cleft fistulas: Report of a case of bilateral aural fistulas and bilateral thymic duct fistulas

A complete second branchial fistula in a four years old child