Excision Of Branchial Cleft Cysts Research Articles

Age-related outcomes after pediatric branchial cleft cyst excision via NSQIP-P

ObjectiveBranchial cleft cysts present at varying ages; sometimes excision is delayed because of concern about operating in small children. Our goal was to determine if outcomes and complications differed among pediatric age groups. Study designRetrospective, cross-sectional. SettingAmerican College of Surgeons’ National Surgical Quality Improvement Pediatric database. MethodsPatients who underwent a branchial cleft cyst excision between 2016 and 2020 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Pediatric database. Patients with CPT code 42,815: ‘excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues and/or into the pharynx’ as their primary procedure were included. Variables of interest included patient demographics, comorbidities, pre-operative risk factors and complications. Results2267 patients with median age of 3.9 (IQR: 7.4, range: 0.04–17.9) years were included. The most common pre-operative risk factors were 149 (7 %) patients with prematurity, 136 (6 %) with developmental delay, 135 (6 %) with congenital malformation, and 128 (6 %) with open wound or wound infection. 68 (3 %) patients experienced at least one post-operative complication, with 73 post-operative complications documented in total. Surgical site infections were the most common complications with 49 (67.1 %) superficial infections, 11 (15.1 %) deep infections, and 4 (5.5 %) organ/space infections. Surgical site infections were the most common reason for related readmission. Duration of anesthesia and operative time increased significantly as patient age increased (p < .001 for both). There was no significant correlation between age and complication incidence. ConclusionBranchial cleft cyst excision is a relatively safe operation with a low complication rate, even in young pediatric populations.

PATTERNS IN WOUND HEALING PROCESS AFTER BRANCIAL CLEFT CYST EXCISION IN CHILDREN

The course of the wound healing process after surgical intervention on brancial cleft cyst excision should be considered as a stereotyped inflammatory-reparative reaction of the body, characterized by staged aseptic inflammation, regeneration and fibrosis. Clinically and even morphologically, it is difficult to determine the stages of the wound healing process in the temporal aspect, since they are consistent and interconnected.&#x0D; Purpose. The paper is aimed at evaluation of the wound healing process according to clinical indicators in children after branchial cleft cyst excision.&#x0D; Methods and Material. 26 children aged from 5 to 17 years old with branchial cleft cysts have been examined and treated. In the postoperative period, the nature, amount of exudate and its cell composition has been determined; skin contact thermometry has been performed at 4 points around the wound at a distance of 1 cm.&#x0D; Results. The first manifestations of the disease coincided with the course of acute respiratory viral diseases in 8 children (30.8%); association with ENT pathology was observed in 3 (11.5%) children and the cystic masses emerged spontaneously in 15 cases (57.7%). They were localized with almost the same incidence on the left and right, but the vast majority (21 cases (80.7%)) was located anteriorly the sternocleidomastoid muscle and in 5 (19.3%) cases behind it. Ultrasound examination, made in 21 patients (80.8%), has revealed the presence of cystic masses with clear contours, hypoechoic structure and fine-grained inclusions, and the wall thickness varied from 1 to 3 mm. In 5 doubtful cases (19.2%) a puncture biopsy was performed.&#x0D; On 1st day after surgery, hyperemia around the wound was moderate in 15 children (57.7%); it was insignificant in 8 (30.8%) children and it was absent in 3 (11.5%) children. At the same time all children experienced collateral edema of various localization and painful modality. In the impression smears, a significant number of neutrophils, a moderate number of lymphocytes and erythrocytes was detected, which were prominent against the background of a loose substrate. The temperature of the wound area was 36.24 ± 0.07˚C, which was higher compared to the control group (34.71 ± 0.12˚C).&#x0D; On 3rd day, the corolla of hyperemia around the wound was not detected in 18 patients (69.2%), and its narrowing was recorded in 6 (23.1%) cases and it was persistent in 2 (7.7%) cases. On palpation, severe, moderate and weak pain on the wound area was experienced by 2 (7.7%), 15 (57.7%) and 9 (36.4%) children, respectively. The cytograms of the exudate showed a reduced quantity of neutrophils, erythrocytes and lymphocytes. Two children showed elevated quantity of destructured neutrophils and local temperature to 37.21 ± 0.16 ° C, which required medical adjustments.&#x0D; A narrow corolla of hyperemia around the wound, slight edema and moderate pain was detected on 7th day only in 2 children. In all patients, palpation revealed tissue compaction along the wound canal, onset of epithelialization, and the cytograms revealed the presence of sporadic neutrophils. The temperature of the skin around the wound reached 35.74 ± 0.11˚C, which was almost similar to controls (34.21 ± 0.08˚C). In all cases, the wounds healed with primary tension.&#x0D; Thus, the nature of the dynamics of wound healing after brancial cleft cyst extirpation in children can be successfully controlled by the prominence of the main clinical signs, the findings of the study of cellular composition of wound exudate and local temperature measuring.&#x0D; The perspectives of further research are associated with availability and simplicity of the methods in terms of their application in everyday clinical practice.

The Fellowship Effect: Does Surgical Subspecialty Training Affect Pediatric Surgery Case Volume?

The Accreditation Council for Graduate Medical Education (ACGME) monitors fellow case numbers. Previous literature has shown new fellowships detrimentally affecting general surgery residency case numbers. We hypothesize that an increase in pediatric otolaryngology and pediatric urology fellowships would decrease overlapping case numbers in pediatric surgery fellowships. A review of each specialties' fellowship match results was performed. Publicly available pediatric surgery cases logs were reviewed for overlapping cases including thyroidectomy, parathyroidectomy, branchial cleft cyst excision, thyroglossal duct cyst excision, major neck tumor excision, nephrectomy, orchidopexy, inguinal hernia, and testicular torsion. Analyzed data included average case numbers and number of fellows each year. Linear regression analysis was performed. We identified a significant increase in fellowship graduates from 2003 to 2018 (p < 0.006). Reviewed cases showed little fluctuation despite an increase in graduates. A decrease in tumor-related nephrectomies and orchidopexies was identified for pediatric surgery fellows (p < 0.001; p < 0.004). Though significant, nephrectomy fluctuation was between 2 and 4 cases. Similarly, we identified a significant rise in thyroidectomies (p < 0.001). Again, the increase was by 3 cases each year. Despite the increase in number of fellowships, there has been a minimal overall effect on pediatric surgery case volume. Continuing to monitor these trends will help ensure adequate training for all pediatric surgical subspecialties.

Postoperative Outcomes of Branchial Cleft Cyst Excision in Children and Adults: An NSQIP Analysis.

Identify risk factors and perioperative morbidity for patients undergoing branchial cleft cyst (BCC) excision. Cross-sectional analysis. American College of Surgeons National Surgical Quality Improvement Program adult and pediatric databases (NSQIP and NSQIP-P). Patients who underwent BCC excision (Current Procedural Terminology 42810, 42815) were queried via NSQIP (2005-2016) and NSQIP-P (2012-2016). Outcomes analyzed include patient demographics, medical comorbidities, admission type, operative characteristics, length of hospital stay, postoperative complications, and readmission. A total of 1775 children and 677 adults were identified. Mean age at time of surgery was 4.6 years for children and 38.6 years for adults. Outpatient procedures were performed in 87.1% of adults and 94.0% of children (P < .001). Postoperative complications were uncommon, occurring in <1% of adults and 3.9% of children (P < .001). Similarly, readmission occurred in 1.2% of adults and 1.1% of children. In adults, smoking status was shown to have a significant effect on postoperative complications (odds ratio, 6.25; P = .037). Age group did not have an effect on the complication rate in the pediatric population. Pediatric otolaryngologists had higher rates of postoperative complications (P = .001), prolonged operative times (P < .001), and fewer outpatient procedures (P < .001). Conversely, in adults, otolaryngologists had fewer postoperative complications. Postoperative complications following BCC excision are relatively uncommon, demonstrating procedural safety when performed at any age.

A cross-sectional evaluation of outcomes of pediatric branchial cleft cyst excision

ObjectiveTo examine complications following pediatric branchial cleft cyst excision by surgical specialty, demographics, and comorbid conditions. MethodsA retrospective review of the National Surgical Quality Improvement Program database was performed. Pediatric cases from January 1, 2015 through May 1, 2017 with a current procedural terminology code of 42810 (excision branchial cleft cyst or vestige, confined to skin and subcutaneous tissues) or 42815 (excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues and/or into the pharynx) were included. Statistical analysis was performed to assess associations between complications and surgical specialty, demographics, and comorbidities. ResultsOf the 895 cases that met inclusion criteria, the median age was two years and there was an approximately equal number of males (46.8%) and females (53.2%). Forty-five patients (5.0%) experienced at least one 30-day complication, the most predominant of which was superficial surgical site infection. There was no statistically significant difference between complications and surgical specialty, complications and patient demographics, or complications and depth of excision. There was a statistically significant difference (p = 0.05) in the percentage of patients with a past medical history of developmental delay between those with at least one complication (11.1%) compared to those without any complications (4.2%). Conclusion and relevanceBranchial cleft excision is a generally safe procedure across surgical specialties and patient demographics. There is an association between a history of developmental delay and 30-day postoperative complications.

Recurrent Branchial Cleft Cyst with Symptomatic Cervical Oesophageal Diverticulum in Adult -An Interesting Presentation of Incomplete Branchial Cleft Cyst Excision

Recurrent Branchial Cleft Cyst with Symptomatic Cervical Oesophageal Diverticulum in Adult -An Interesting Presentation of Incomplete Branchial Cleft Cyst Excision

Endoscopic Excision of Branchial Cleft Cyst in the Neck Using Mammary Areolae and Axilla Approach

Branchial cleft cysts are prone to recurrence and secondary infections, and hence, surgical resection is necessary. These masses are traditionally removed through an overlying incision; however, the resulting scar can be considered aesthetically displeasing. We accomplished a case of endoscopic resection of branchial cleft cyst in the right side of the neck of an 18-year-old female patient. Incisions were made in the bilateral mammary areolae and right axilla of the patient. We completely resected the mass using an ultrasonic scalpel and electrocoagulation hook within 45 minutes. All of the procedures were finished on the deep face of platysma muscle, which was not severed. There was no significant bleeding during the operation and the postoperative recovery was smooth, without recurrence for 6 months. The endoscopic resection of the neck mass through bilateral areolae and axillary incisions is simple, safe, and feasible, because there were covert incisions and fewer complications.

Atypical Presentation of Thyroglossal Duct Cyst in a Pediatric Patient

Atypical Presentation of Thyroglossal Duct Cyst in a Pediatric Patient

Patent Piriform Sinus Fistula in a Third Branchial Cleft Cyst

OBJECTIVE: To determine if a patent branchial cleft fistula is identifiable and treatable via direct laryngoscopy. BACKGROUND: Third branchial cleft cyst fistula tracts are rare. Complete surgical excision is the treatment of choice; however complications can include recurrent abscess and fistula tract formation. RESULTS: This report illustrates the use of suction cautery to close a patent fistula found within the piriform sinus after multiple resections. CONCLUSION: We believe thorough endoscopy should be performed with every surgical excision of branchial cleft cyst. Case Continued: The decision was made at that time to take the patient to the OR for cauterization of the fistula. The patient was taken to the OR on 7/28/09 where she underwent general anesthesia and endotracheal intubation without difficulty. A Dedo laryngoscope was inserted into the left piriform sinus and using a zero degree Hopkin’s rod a patent fistula was identified (Figure 2). A probe was inserted into the fistula and under direct visualization suction electrocautery was used to scar the fistula tract closed (Figure 3 and 4). The patient tolerated this procedure well and was admitted overnight for airway observation. She was discharged home on post operative day one with a soft diet for two weeks. The patient returned to clinic for follow up and underwent indirect laryngoscopy which demonstrated a well healed left piriform sinus and normal true vocal cord mobility. The patient is currently four months post operative without any complications.

Removal of pediatric branchial cleft cyst using a retroauricular hairline incision (RAHI) approach

Branchial cleft cyst (BCC) is treated surgically using a transcervical approach, leaving potential cervical scars. This prospective study assessed the outcomes of retroauricular hairline incision (RAHI) approach for BCC excision in children. Twelve patients with second BCC (age < 18 years) underwent cyst excision via the RAHI approach, with incision along the postauricular sulcus and hairline. The operation time, complications, and subjective satisfaction with incision scars were assessed. Mean operation time was 45 +/- 12 min. There were no significant complications, except for temporary hypoesthesia of the earlobe. Hypertrophic scars at incision sites occurred in two patients, but these scars are usually hidden by the natural hair and auricle. Mean subjective satisfaction score regarding incision scars was 8.7 +/- 0.9 out of 10. The RAHI approach may provide good aesthetic results without significant surgical morbidities. This may be an alternative option for the surgical excision of BCC for children and their parents who desire invisible external scars after surgery.

First branchial cleft cyst excision with electrophysiological facial nerve localization.

To assess the safety and efficacy of surgical excision of selected first branchial cleft cysts using electrophysiological rather than anatomical location of the facial nerve. Retrospective review of consecutive surgical procedures by a single surgeon, using a consistent technique during a 9-year period. Tertiary pediatric medical center. Eleven children with first branchial cleft cysts. Selected first branchial cleft cysts were removed using a smaller surgical approach than that generally advocated. The facial nerve was localized using electrophysiological means rather than superficial parotidectomy and identification of the nerve trunk and branches. Successful removal of the lesion, avoidance of facial nerve injury, incidence of Fry syndrome, and cosmesis. Eleven patients underwent surgical excision of first branchial cleft cysts during a 9-year period. Ten lesions were removed without the need for anatomical localization of the facial nerve trunk. There was no facial weakness, recurrence of the lesions, or Fry syndrome during a follow-up of 6 months to 7 years. Cosmesis was superior. Electrophysiological location of the facial nerve may, in the appropriate setting, replace anatomical localization for first branchial cleft cysts that are (1) superior to the stylomastoid foramen and (2) not previously infected or surgically violated.