Branchial Apparatus Research Articles

Supra-auricular presentation of a first branchial cleft anomaly

Branchial anomalies are congenital lesions that occur as a result of incomplete obliteration of the branchial apparatus during foetal development. Due to their complex presentations, they are commonly misdiagnosed and pose a challenge in treatment. This report features a girl, aged 1 year and 2 months, with Goldenhar syndrome with right microtia, presenting with a rare supra-auricular fistulous opening to the external auditory canal, with a communicating tract in the neck.

Diagnosis and advances in the tumors of ectopic thymic or branchial apparatus differentiation

异位胸腺或鳃器分化的肿瘤相关报道日益增多，其包含异位胸腺瘤、异位错构瘤性胸腺瘤、伴胸腺样分化的梭形细胞肿瘤以及伴胸腺样分化的癌，认识和掌握此类肿瘤的临床病理学特征、诊断和治疗具有重要意义。本文对异位胸腺或鳃器分化的肿瘤的组织起源、流行病学特征、临床病理学特征、分子特征、诊断及鉴别诊断、治疗以及预后等方面进行了分析总结和综述，旨在提高临床以及病理医师对此类肿瘤的认识以及诊断能力。.

Prenatal Diagnosis of Third and Fourth Branchial Apparatus Anomalies: Case Series and Comparison with Lymphatic Malformation.

Third and fourth branchial apparatus anomalies are rare congenital anomalies. The purpose of this study was to investigate imaging features of these lesions on fetal MR imaging in comparison with lymphatic malformations, the major competing differential diagnosis in these cases. A retrospective review of our institutional fetal MR imaging database between 1997 and 2019 resulted in 4 patients with confirmed third and fourth branchial apparatus anomalies and 14 patients with confirmed lymphatic malformations. The imaging features were reviewed by consensus, and the Fisher exact test was used to evaluate statistically significant differences between these 2 populations. Four cases of third and fourth branchial apparatus anomalies were imaged at 29 weeks 1 day (range, 23 weeks 1 day to 33 weeks 4 days). All 4 cases demonstrated unilateral, unilocular cysts without reduced diffusion or hemorrhage and a medially directed beaked contour that tapered between the spine and airway at the level of the piriform sinus. Compared with 14 cases of fetal lymphatic malformations imaged at 27 weeks 6 days (range, 21 weeks 3 days to 34 weeks 6 days), third and fourth branchial apparatus cysts were significantly more likely to be unilocular (P < .005) and to have a medially beaked contour (P < .005). The combination of features of unilateral, unilocular, and medially beaked contour was observed only in the fetuses with third and fourth branchial apparatus cysts (P < .001). The presence of a left-sided unilocular cyst with a medially beaked contour tapering at the level of the piriform sinus suggests the diagnosis of third and fourth branchial apparatus anomaly. Accurate diagnosis in the prenatal period allows proper counseling, genetic work-up, and treatment, potentially sparing patients from recurrent infections and associated morbidity.

Branchial cleft cyst. Particularities of diagnosis and treatment. Clinical case

Branchial cysts are rare congenital malformations which arise due to the partial or complete involution of branchial apparatus in the development of the human embryo, causing huge discomfort to the patient. The objective of the study is to investigate the clinical picture, the evolution, the diagnostic methods of the branchial cysts to optimize the treatment tactics. A clinical case will be presented of a 40–years–old patient which was admitted to IMU IMSP in the Oral and Maxillofacial Surgery Department with the diagnosis of a left lateral branchial cyst. The patient accuses aesthetic disorders and the presence of a voluminous swelling which was located in the upper left lateral cervical region that began 2 years ago with episodes of frequent superinfection, gradually increasing in size. Therefore, a clinical and paraclinical examination was performed (laboratory tests, ultrasonography) to specify the diagnosis and to provide additional information on adjacent anatomical structures that may influence the tactics of the surgical treatment. A surgical intervention such as „removal of the swelling” was advised. Following the excision of the cyst under general anesthesia, the postoperative period passed without any particularities. Early diagnosis will reduce the increase in size of the branchial cysts preventing inflammatory complications with their superinfection.

Fourth Branchial Anomalies: Diagnosis, Treatment, and Long-Term Outcome.

Introduction: Fourth branchial anomalies, the rarest among anomalies of the branchial apparatus, often present diagnostic and therapeutic challenges. We evaluated the clinical presentation and radiographic features, the treatment and the long-term outcome of patients in this setting.Patients and Methods: Of 12 patients treated in the University Hospitals Leuven from 2004 until 2020, 12 variables were collected: date of birth, gender, age of onset of the symptoms, age at final diagnosis, presentation, laterality, previous procedures, diagnostic tools, treatment (open neck surgery, endoscopic laser excision, or combination), complications, recurrence, and period of follow-up. Descriptive statistics were calculated and results were compared to the existing literature.Results: The most common clinical manifestations were recurrent neck infections with and without abcedation. Definitive diagnosis using direct laryngoscopy, visualizing the internal sinus opening, was possible in all patients. A CT study revealed the typical features of fourth branchial anomalies in seven patients out of nine, an ultrasound study in five out of nine patients. All patients underwent open neck surgery. If this was insufficient, secondary endoscopic laser resection of the ostium at the apex of the piriform sinus was performed (n = 4). In eight patients a thyroid lobectomy was needed for safe complete resection. Postoperative complications were minimal and at long-term, none of the patients showed further recurrence. Average time of follow-up was 8.6 years.Conclusions: Direct laryngoscopy and CT are the most accurate diagnostic tools. Our recommended treatment schedule consists of complete excision of the sinus tract by open neck surgery as the primary treatment because this ensures the best results. In case of recurrence afterwards, endoscopic laser resection of the pharyngeal ostium solved the problem.

Patho-Anatomic Spectrum of Branchial Cleft Anomalies: Proposal of Novel Classification System

Histogenesis, nomenclature, and classification of branchial cleft anomalies (BCAs) have been subjects of controversy for decades. The purpose of this study was to investigate the accuracy of current developmental theories (congenital, lymph node, and hybrid branchial inclusion theories) in defining the anatomic and histopathological characteristics of BCAs. Ninety consecutive patients with BCAs who underwent surgical excision were enrolled in this 2-center retrospective cohort study. The present study included 90 patients: 46 (51.11%) women and 44 (48.89%) men (P > .05). The mean age at presentation was 31.89±17.31 years. Altogether, 92 BCAs were identified within the study population including 49 (53.26%) on the left side and 43 (46.74%) on the right side (P > .05). The BCAs included 79 (85.87%) branchial cleft cysts, 11 (11.96%) branchial cleft sinuses, and 2 (2.17%) branchial cleft fistulae. Three (3.26%) BCAs were distributed in the head regions, 88 (95.65%) in the neck regions, and 1 (1.09%) in the thoracic cavity. Following surgery, lymphoepithelial tissue was detected in the histopathological examination in 83 (90.22%) BCAs. The hybrid branchial inclusion theory exhibited significantly higher accuracy in defining patho-anatomic characteristics of BCAs than the branchial apparatus, precervical sinus, thymopharyngeal, and inclusion theories (90.22, 9.78, 2.17, 0.00, and 0.00%; respectively) (P < .05). The novel branchial node (BN) classification system based on the hybrid branchial inclusion theory appears to be superior to other classification systems in determining the patho-anatomy of BCAs.

Endoscopic coblation treatment for congenital pyriform sinus fistula in children.

Congenital pyriform sinus fistula (CPSF) is a very rare branchial apparatus malformation. Traditional open surgery for fistulectomy might fail to excise the lesion completely, leading to continual recurrence. Herein, we report our experience of endoscopic coblation technique for treatment of CPSF in children.To observe the clinical efficacy of endoscopic coblation treatment of CPSF in children, especially for those in acute infection stage.Retrospective case series with 54 patients (including 20 cases in acute infection stage and 34 cases in non infection stage) who were diagnosed with CPSF between October 2017 to November 2019, all patients were treated with endoscopic coblation to close the piriform fossa fistula, neck abscess incision and drainage performed simultaneously for acute infection stage cases. Data collected including age of diagnosis, presenting symptoms, diagnostic methods, prior and subsequent treatments, length of hospitalization, and recurrence were analyzed.Of the 20 cases in acute infection stage, there were 3 children with transient vocal cord paresis all of which resolved with 1 month. Four children of the 34 cases in non infection stage appeared reddish swelling of the neck on the 4th, 5th, 6th, and 7th days after coblation and then underwent abscess incision and drainage. All cases experienced no recurrence, vocal cord paralysis, pharyngeal fistula and massive hemorrhage after their first endoscopic coblation of the sinus tract in the follow up of 3 to 28 months.Endoscopic coblation is an effective and safe approach for children with CPSF, neck abscess incision and drainage could be performed simultaneously in acute infection stage. We advocate using this minimally invasive technique as first line of treatment for CPSF.

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

Branchial cleft cysts are frequent causes of congenital neck masses-second only to thyroglossal duct cysts. Often asymptomatic, these masses can be missed until adulthood. The branchial apparatus is comprised of 3 parts: Arch, cleft, and pouch; these parts develop into the soft tissue, cartilaginous, and bony structures the mandible and neck. Incomplete obliteration is thought to result in branchial anomalies.

Branchial cleft anomalies: hybrid "Branchial Inclusion" theory.

Branchial cleft anomalies (BCAs) are developmental malformations of the head and neck region. Their histogenesis has been the subject of controversy and is not fully understood. This study aimed to test all present developmental theories ("branchial apparatus," "precervical sinus," "thymopharyngeal," and "inclusion" theories) on a sample of 48 BCAs from a single institution. We performed a retrospective analysis of clinical-epidemiological and anatomical-pathological characteristics of BCAs treated over a 12-year period in our hospital. Overall, 46 patients (24 [52.17%] women and 22 men [47.83%]) underwent surgical excision of 48 BCAs. The mean patient age at presentation was 31.65 ± 19.40years. Branchial cleft cysts were found in 42 (87.50%) cases, and branchial cleft sinuses were found in six (12.50%) cases. Eight (16.67%) BCAs were distributed in the preauricular region, 34 (70.83%) at the anterior border of the sternocleidomastoid muscle (SCM), three (6.25%) at the posterior border of the SCM, two (4.17%) in the suprasternal notch, and one (2.08%) in the retrosternal space. Histopathologically, 39 (81.25%) BCAs had a lymphoepithelial structure and nine (18.75%) BCAs had solitary epithelial cells. Inflammation and infection were observed in 24 (50%) and 12 (25%) cases, respectively. None of the hypothesized developmental theories fully explain the embryonic origin of BCA in our study sample. A possible explanation of BCA histogenesis is through the hybrid "branchial inclusion" theory.

Complete First Branchial Fistula in a Child Extending from the External Auditory Canal to the Oropharynx

We report the clinical presentation and CT and MR imaging findings in a child with an unusual first branchial apparatus fistula that extends from the external auditory canal to the oropharynx.

Combination Surgical Procedure for Fourth Branchial Anomalies: Operative Technique and Outcomes.

Branchial apparatus anomalies of the fourth cleft are the rarest subtype of anomaly and occasionally present with suppurative thyroiditis or thyroid abscess due to their relationship with the thyroid gland. Surgical approaches vary and some surgeons favor cauterization of associated pyriform sinus tracts alone versus complete surgical excision. Currently, the literature is scarce and there is limited data on surgical outcomes and procedural steps. Here we describe a combination surgical technique for fourth branchial anomalies including: (1) surgical excision of the cyst and any external pit, (2) hemithyroidectomy, and (3) direct laryngoscopy with cauterization of pyriform apex tract, if present. A retrospective review was performed on all patients who underwent surgical excision of fourth branchial apparatus lesions (including fistulae, cysts, and sinus tracts) at an urban pediatric university hospital from 2000 to 2019. Data regarding demographics, medical history, surgical methods, complications, and surgical cure rates were collected. A total of 16 patients (9 female, 7 male) underwent a combination surgical procedure for fourth branchial apparatus lesions. Success rate after primary surgery was 94%. One patient had residual disease requiring re-operation. Two patients had post-operative complications: 1 transient vocal fold paresis and 1 seroma, both managed conservatively. A consensus surgical algorithm was created based on operative steps present in the majority of cases. A combination approach to fourth branchial apparatus lesions-including endoscopic cauterization, external excision, and hemithyroidectomy-is safe and provides a high rate of primary cure. Although less invasive options exist, remnants of the branchial lesion, especially in the thyroid, may remain and cause recurrent issues. Therefore, we advocate for complete surgical excision of this rare developmental anomaly, especially when obvious thyroid involvement exists.

Fourth Branchial Pouch Sinus: A Rare, Often Misdiagnosed Congenital Anomaly.

Pathologies of the branchial apparatus originate from abnormal embryological development and frequently affects the second branchial cleft. Fourth branchial cleft lesions are exceptionally few and existing literature on it is scarce. We present a case of a fourth branchial pouch sinus, masquerading as a recurrent neck abscess.

Incidence and Outcome of Second Branchial Cleft Anomalies: A Three Years Experience and Appreciation

Background: Second branchial cleft anomalies are remarkable of all other inborn errors of branchial apparatus. As a congenital, it may be presented at birth but usually manifests in early teenagers and young adults. Like all other inborn errors, it is better to correct earlier before suffering from any complications. Methods: It is a cohort retrospective study of 15 cases in the Department of Otolaryngology and Head-Neck Surgery, Cumilla Medical College, and Cumilla Medical Centre, Bangladesh, from 01 July 2016 to 31 June 2019. Results: Incidence of anomalies among routine ENT operations was 0.21%. Of 15, the cyst was 04(26.27%), sinus was 10(66.66%), the fistula was 1(6.67%), children were 09(60%), the adult was 6(40%), and young adult and an early teenager were 07(46.66%), male was 11(75.33%), and females were 04(26.27%), bilateral were 2(13.33%), unilateral was 13(86.67%) in which right was 10(76.33%), and left was 03(23.08%), painful cyst with abscess was 01(6.67%), the painless cyst was 03(20%), sinus with the mucoid fluid discharge was 07(46.68%), painful sinus with mucopurulent discharge and skin-excoriation was 03(20%), painful fistula with mucopurulent discharge and skin-excoriation was 01(6.67%), post-operative wound infection was 2(13.33%). Recurrence and the branchio-oto-renal syndrome were absent in our study.

SAT-063 Polymicrobial Suppurative Thyroiditis Masquerading as Thyroid Storm

Introduction:The thyroid gland is highly resistant to infection due to a robust blood supply, good lymphatic drainage, and high iodine concentration. Suppurative thyroiditis (ST) often presents with fever, tachycardia, leukocytosis, tenderness, and euthyroid labs. However, when ST occurs with thyrotoxicosis, it can meet criteria for thyroid storm, which presents a diagnostic dilemma.Clinical Case:A 17 year old female with family history of Graves’ disease presented to the ER with a sore throat. She was diagnosed with viral pharyngitis and treated with dexamethasone. Over the next 2 weeks, she developed fatigue, body aches, nausea, vomiting, and chills. She returned to the ER and was found to have tachycardia, hyperthyroidism [free T4 5.64 ng/dL (0.8 - 2.0 ng/dL), TSH <0.015 uIU/mL (0.5 - 4.5 uIU/mL)], and WBC 11 k/uL (3.5 - 11.5 k/uL). She was prescribed atenolol and referred to Endocrinology. Three days later she developed fever, diaphoresis, ear pain, vomiting, and abdominal pain. In the ER, she was febrile to 101.2°F with a heart rate (HR) of 117 BPM. Labs showed a free T4 6.14 ng/dL, TSH <0.015 uIU/mL, and WBC 20 k/uL. She was treated with methylprednisolone, propylthiouracil, and labetalol with improvement and transferred for concern of impending thyroid storm. Exam showed left-sided thyroid enlargement with tenderness. Thyroid ultrasound showed an enlarged heterogenous left thyroid lobe with 2 nodules, one 25 x 33 x 21 mm heterogenous and one 19 x 11 x 19 mm homogenous, without discrete abscess. That night she developed vomiting, hand tremors, HR in the 130’s BPM, fever to 104.1°F, and a headache. Treatment was initiated with methimazole, SSKI drops, propranolol, and dexamethasone. Symptoms improved save persistent neck tenderness and dysphagia. CT neck demonstrated a left-sided 25 x 17 x 90 mm abscess with concern for 4th branchial apparatus abnormality. She underwent incision and drainage with drain placement. Cultures grew Streptococcus anginosus and Fusobacterium necrophorum. Broad spectrum antibiotics were started and later narrowed to ampicillin-sulbactam. Betablockers and methimazole were discontinued and thyroid labs nearly normalized by discharge [T4 11.8 mcg/dL (4.5-11.5 mcg/dL), free T4 2.0 ng/dL (0.8-2 ng/dL), and total T3 78 ng/dL (100-210 ng/dL)]. Thyroid auto-antibodies were negative.Discussion:In patients with ST, only 11% present with hyperthyroidism. Current thyroid storm scoring systems are sensitive but not specific so an acute bacterial infection with thyrotoxicosis can easily meet criteria. While ultrasound is standard for assessing for thyroid abscesses, in the setting of high clinical suspicion, further imaging with contrasted neck CT is warranted.

Development of an adverse outcome pathway for cranio-facial malformations: A contribution from in silico simulations and in vitro data

Mixtures of substances sharing the same molecular initiating event (MIE) are supposed to induce additive effects. The proposed MIE for azole fungicides is CYP26 inhibition with retinoic acid (RA) local increase, triggering key events leading to craniofacial defects. Valproic acid (VPA) is supposed to imbalance RA-regulated gene expression trough histone deacetylases (HDACs) inhibition. The aim was to evaluate effects of molecules sharing the same MIE (azoles) and of such having (hypothetically) different MIEs but which are eventually involved in the same adverse outcome pathway (AOP). An in silico approach (molecular docking) investigated the suggested MIEs. Teratogenicity was evaluated in vitro (WEC). Abnormalities were modelled by PROAST software. The common target was the branchial apparatus. In silico results confirmed azole-related CYP26 inhibition and a weak general VPA inhibition on the tested HDACs. Unexpectedly, VPA showed also a weak, but not marginal, capability to enter the CYP 26A1 and CYP 26C1 catalytic sites, suggesting a possible role of VPA in decreasing RA catabolism, acting as an additional MIE. Our findings suggest a new more complex picture. Consequently two different AOPs, leading to the same AO, can be described. VPA MIEs (HDAC and CYP26 inhibition) impinge on the two converging AOPs.

Osteological plasticity of Garra rufa populations in Iranian inland waters (Teleostei: Cyprinidae)

Osteological plasticity of Garra rufa (Heckel, 1843) populations inhabiting 29 rivers in four basins were described and compared. The skeletal elements of G. rufa specimens were stained, cleared and photographed. Studied populations have 12 differences in the head skeleton, four in jaw elements, three in suspensorium, two in opercular series, two in circumorbital series, four in hyoid arches, one in the branchial apparatus, three in Weberian apparatus, three in dorsal fin skeleton, one in anal fin skeleton, one in pectoral fin girdle, three in ventral fin skeleton and two in caudal fin skeleton. These differences could be results of evolutionary adaptations to new habitat conditions and can be used in comparative and phylogenetic studies.

Biphenotypic Branchioma: A Better Name Than Ectopic Hamartomatous Thymoma for a Neoplasm with HRAS Mutation.

Ectopic hamartomatous thymoma is a rare neck lesion originally thought to represent a non-neoplastic hamartoma, even though thymic origin has been questioned, and there is uncertainty about whether the lesion is a neoplasm. We investigated the genetics by performing targeted next generation sequencing (NGS). Three cases were identified from the authors' consultation files. A custom, targeted NGS panel including 1385 pan-cancer-related genes was performed on all cases. Three patients included 2 males and 1 female, aged 50, 58 and 70years, respectively (mean 59.3years), with tumors arising in the low anterior neck. All cases showed classical histologic features of EHT, with one case showing intraductal carcinoma in association with the EHT. By targeted NGS, one case harbored a hotspot HRAS mutation (p.Gln61Lys), while the other two cases only showed non oncogenic variants. Dual mesoderm and endoderm derivation/differentiation (biphenotypic) has been previously recognized, with epithelial and myoepithelial components, and arising from the apparatus contributing to neck development (branchial apparatus). Thus,EHT has been shown to havegenetic alterations inHRAS. These findings, without evidence of thymic derivation or an ectopic tissue location, strongly support that EHT is a true neoplasm. The name biphenotyic branchioma more correctly reflects the true nature of this dual mesoderm and endoderm derived tumor occurring in the lower neck.

Osteocranium of Tor tambroides (Cypriniformes: Cyprinidae) from Tangse River, Aceh, Indonesia

Abstract. Akmal Y, Zulfahmi I, Dhamayanti Y, Paujiah E. 2020. Osteocranium of Tor tambroides (Cypriniformes: Cyprinidae) from Tangse River, Aceh, Indonesia. Biodiversitas 21: 442-450. We report the first detailed descriptive osteocranium of keureling, Tor tambroides (Cypriniformes: Cyprinidae) collected from Tangse River, Indonesia. This study aimed to describe the cranium morphology of keureling (Tor tambroides). Keureling fish used in this study were obtained from the catch of fishers in the Tangse River, District of Pidie, Aceh Province, Indonesia. Stages of research include sample preparation, bone preparations, and identification of cranium nomenclature. For osteological examination, the cranium of the keureling prepared physically and chemically. Based on the results, the cranium of the keureling is divided into two major parts, namely the neurocranium and the facial bone,s including the branchial apparatus. The neurocranium is divided into (anterior to posterior) olfactory (ethmoid), orbital, otic, and occipital regions while the rest divided into oromandibular, opercular series, branchial arch, mandibular arch, and hyoid arch (suspensorium) regions. The neurocranium includes bones in the dermal series of the skull and endochondral bones protecting the brain. At the same time, branchiocranium are those located in the oromandibular part, opercular series, and branchial arch.

Surgical treatment of fourth branchial apparatus anomalies: a case series study

BackgroundFourth branchial apparatus anomalies, are rare clinical entities, and present as complex cysts, sinuses and fistulae in the neck that can be difficult to manage.MethodsThis is a retrospective review of a series of consecutive patients with fourth branchial apparatus anomalies treated at Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, from Apr 2014 to Nov 2019.ResultsTen patients with fourth branchial apparatus anomalies were identified, including 8 patients with fourth branchial fistula, and 2 patients with fourth branchial pouch sinus. There were 6 female patients and 4 male patients. Their age was from 6 years old to 39 years old (average age 20.4 years old, median age was 21 years old). All 8 fistulae were on the left side, while 2 pouch sinuses were both on the right side. Pre-operative examination with fiberoptic laryngoscope, barium swallow X-ray, CT or MRI identified internal orifice at pyriform fossa apex in 8 (80%) patients. All patients underwent challenging surgical resection by the senior author. Intra-operative direct laryngoscope confirmed or identified internal orifice in 9 (90%) patients. The tracts were all followed to the vicinity of inferior cornu of the thyroid cartilage and the cricothyroid space. Complete resection of cervical lesions and their attachment to hypopharynx were achieved in 9 cases. No complication occurred. One recurrence was detected, in the only patient whose internal orifice could not be located pre- or intra-operatively, and the hypopharyngeal attachment could not be removed.ConclusionsDirect laryngoscopy under general anesthesia is a reliable method of diagnosis for the fourth branchial apparatus anomalies. Complete surgical removal of fourth branchial apparatus anomalies, including their hypopharyngeal attachment, is the treatment of choice, and the key to prevent recurrence.

Enigma in the diagnosis of congenital neck masses: a prospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Head and neck swellings are common in routine otorhinolaryngologic practice. This study was done to assess the incidence and varied presentation of different congenital neck swellings.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Hospital based prospective study done in the Department of Otorhinolaryngology at a tertiary care hospital from January 2017 to December 2018. A total of 28 patients with slow, progressive neck swellings were selected after excluding thyroid swellings and acute inflammatory neck swellings. All patients had no other complaints. After a thorough clinical examination and investigations like ultrasonography, fine needle aspiration cytology and radiological examination, surgery was done, and specimens obtained were sent for histopathological examination. Patients were followed up to 1 year. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 28 patients with congenital neck mass were studied. 15 were thyroglossal cysts, 7 were branchial anomalies, 5 were dermoid cysts and 1 was bronchogenic cyst. The most frequent congenital neck mass was thyroglossal duct cyst and fistula (53.57%) followed by, in descending order, cysts and fistulas of the branchial apparatus (25%), dermoid cysts (17.85%) and bronchogenic cyst (3.5%) respectively.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The overall presentation in terms of age group, location, incidence and clinical features of congenital neck swellings is an enigma to the treating surgeon as well as the pathologist. The prevalence varies largely among centres. A knowledge of the varied differential diagnosis of slow progressive masses in the neck should be kept in mind while planning the surgical procedure for total removal of the lesion to avoid recurrence.&lt;/p&gt;