First branchial cleft anomalies are uncommon paediatric congenital lesions that may present as persistent pre-auricular or post-auricular sinuses and can involve the parotid region and facial nerve. We present a single-centre 10-year experience describing presentation, imaging, management and outcomes. Retrospective review of a prospectively collected local dataset of paediatric patients with first branchial arch cleft cysts/tracts who underwent evaluation and surgery at a tertiary paediatric centre. Data elements included age at presentation, presenting symptoms, imaging modality, surgical treatment, postoperative complications, facial nerve dysfunction, fistula course, recurrence and follow-up. Eleven patients were included (mean age 5.55 years, median 4 years). The commonest presentation was a persistent sinus with purulent discharge (9/11). Laterality was predominantly left-sided (8/11). MRI was the most used imaging modality (8/11). Postoperative wound infection occurred in 3/11 patients (27%); marginal mandibular branch weakness was recorded in 2/11 (both documented as transient/resolved). One patient had documented recurrence. The fistula/tract most commonly tracked from level II to the ear canal (9/11). In this paediatric series, first branchial arch cleft anomalies most commonly presented as persistent left-sided sinuses with purulent discharge. MRI was commonly used for preoperative assessment. Surgical excision was associated with wound infection in a minority and transient marginal mandibular weakness in several cases. Larger multi-centre series with systematic prospective follow-up are needed.

Branchial cleft cyst carcinomas (BCCC) are rare lateral neck malignancies thought to originate from branchial cleft remnants. Diagnosing primary BCCC should be approached with skepticism; cystic nodal metastasis must be excluded. Due to its rarity, we performed a comprehensive database study to better characterize the ongoing diagnosis of BCCC. Single-arm retrospective cohort study using the TriNetX Research database. Patients ≥ 18 years of age with a diagnosis of BCCC identified by ICD-10 C10.4 between 2008 and 2018 were included, allowing for up to 5 years of follow-up. Demographics, past medical history, oncologic history, diagnostic rate, treatment pathways, and 5-year outcomes including diagnosis with primary HNC and Kaplan-Meier survival curves were analyzed within TriNetX. In 10 years, 1070 patients diagnosed with BCCC were included. The mean age was 59.6 ± 9.7; the majority were male (n = 810, 75.6%) and white (n = 765, 71.4%). Incidence of BCCC increased from 2008 to 2015 and subsequently dropped precipitously. Almost all patients, 94.4% (n = 1011), had prior or subsequent diagnosis of another HNC within 5 years. Five-year survival probability for BCCC was 56.0%. We describe the largest cohort of BCCC patients to date. Most patients were diagnosed with another HNC within 5 years, suggesting a likely misdiagnosis of BCCC. A poor 5-year survival rate may be secondary to a delay in appropriate treatment following an erroneous diagnosis, underscoring the need to approach a diagnosis of BCCC with caution. We consider the use of the BCCC code to be detrimental and recommend its discontinuation.

Cystic neck masses constitute a diverse group of pathological entities that pose diagnostic challenges, particularly in adults where malignant causes must be excluded. Branchial cleft cysts are congenital anomalies that often remain asymptomatic until adulthood, presenting after secondary infection or abscess formation. We report a case of a complicated second branchial cleft cyst in a 38-year-old male presenting with recurrent laterocervical abscess. Diagnosis was established through clinical evaluation, imaging, and histopathological analysis. Initial management involved abscess drainage and exclusion of malignancy, followed by definitive surgical excision after infection resolution. The patient recovered fully without recurrence. This case underscores the importance of a systematic diagnostic approach and timely surgical management to prevent recurrence and complications in adult patients with cystic neck lesions.

Third and fourth branchial cleft anomalies are rare congenital defects affecting children. They arise due to the incomplete obliteration of branchial clefts during embryogenesis. Nearly 90% of the third or fourth branchial pouch sinus tracts are situated on the left side of the neck. It is difficult to differentiate the third and fourth branchial cleft anomalies on radiological imaging due to their close proximity; hence, they may be treated as the same disease. In this report, we describe the case of a 17-year-old male patient with a persistent branchial cleft sinus tract and its clinical presentation, diagnostic evaluation, and surgical management and discuss the preoperative evaluation, pitfalls in diagnosis, and surgical management, including strategies for the management of third or fourth branchial cleft sinus.

IntroductionBranchial cleft cysts (BCC) are congenital cystic lesions of the lateral neck resulting from incomplete obliteration of the branchial clefts during embryogenesis. They are typically located anterior to the sternocleidomastoid muscle and are benign in nature. Papillary thyroid carcinoma (PTC) is the most common histological subtype of thyroid malignancies. Due to its propensity for cervical lymph node metastasis, it may mimic cystic lesions of the lateral neck, posing a diagnostic challenge in adults.Clinical CaseA 35-year-old female presented to the otolaryngology clinic with a painless neck swelling. Physical examination revealed a 3cm lesion in the right level IV region. There was no history of autoimmune thyroid disease, radiotherapy, or family history of thyroid cancer. Ultrasonography showed a normal sized thyroid with a 10×8 mm isohyperechoic nodule in the left lobe, with a regular margin, halo, and peripheral vascularization. In addition, a 30×15 mm anechoic cystic lesion was detected anterior to the sternocleidomastoid muscle and was initially considered as BCC. Fine-needle aspiration biopsy was nondiagnostic. Contrast-enhanced MRI revealed a 17×22 mm well-circumscribed, dense-content lesion, again suggestive of BCC. The patient underwent surgery with this presumptive diagnosis. Histopathological examination demonstrated papillary thyroid carcinoma invasion in the cyst wall, consistent with metastatic PTC. Following multidisciplinary tumor board evaluation, total thyroidectomy with bilateral central and right lateral neck dissection was performed. Postoperative pathology revealed a 0.8 cm oncocytic variant papillary microcarcinoma in the right lobe, with capsular invasion within 0.1 cm, and metastasis in three central lymph nodes. The patient was classified as high-risk and received 150 mCi of radioactive iodine (RAI). Post-therapy I-131 scintigraphy showed uptake confined to the thyroid bed, with no evidence of distant metastasis. During follow-up, TSH was suppressed below 0.1 mIU/L. Stimulated thyroglobulin was 7 µg/L with negative anti-Tg antibodies. At the latest follow-up, thyroglobulin was 0.6 µg/L, consistent with a biochemical indeterminate response.Cystic lymph node metastases of PTC can easily be misdiagnosed as BCC, especially in adults. Several cases in the literature have reported lesions initially excised under the presumptive diagnosis of BCC that were later confirmed as metastatic PTC. Therefore, in adult patients with lateral cervical cystic lesions, careful evaluation is essential, and suspicious radiologic findings must be followed by thorough histopathological analysis. Clinical history, imaging features, and, when necessary, repeat biopsies are crucial for accurate diagnosis.ConclusionPapillary thyroid carcinoma can present as cystic lymph node metastases mimicking branchial cleft cysts; thus, this diagnosis must be considered in adults with lateral neck masses

First branchial cleft anomalies (FBCAs) are the result of misguided embryologic development of the external auditory canal, resulting in a partial duplication of the structure. A recent consensus statement by the International Pediatric Otolaryngology Group (IPOG) reclassified lesions based on anatomic location rather than the classic germ cell layer classification. Type I FBCAs are external and superficial to the parotid fascia, and type II FBCAs are juxtaposed to, or involving, the parotid gland. The consensus statement supports extensive resection to prevent recurrence. We hypothesized that type II FBCAs may be multicentric. The objective of this study was to search for histological evidence of this characteristic which, if present, supports the recommendation of the IPOG consensus for extended surgical resection. Archived histopathologic resections of type II FBCAs were evaluated for satellite lesions or filamentous tracts off the main lesion indicating respiratory epithelium and extension of pathology beyond the typical resection. Pathologic analysis identified 22 archived tissue specimens with adequate histology to evaluate for the presence of FBCA tissue in the parotid gland. 6/22 (27.3%) demonstrated FBCA tissue external to the main lesion or multiple epithelial rests of similar tissue outside the primary lesion consistent with pathology beyond the primary cyst itself. The results support the notion that type 2 FBCAs are extensive and can be multicentric. These findings also support the clinical experience and recommendation of the IPOG consensus statement for a more extensive dissection and removal of surrounding tissue in the effort to best prevent recurrence.

Background Deep neck space abscesses (DNSA) are rare but can be life-threatening due to their rapid progression and variable presentation. Effective management requires prompt diagnosis, appropriate antimicrobial therapy, and timely surgical intervention. Objective To explore the clinical and microbiological characteristics of DNSA and their impact on treatment decisions. Methods This retrospective study analyzed 108 patients with DNSA treated at Eye & ENT Hospital, Fudan University from April 2013 to May 2021. Patient demographics, medical history, clinical symptoms, white blood cell count, imaging results, antibiotic use, and microbiological findings were collected. All patients underwent contrast-enhanced CT, and bacterial cultures guided antibiotic therapy. Results Recurrence of DNSA was strongly associated with undiagnosed branchial cleft fistulas, highlighting the need for thorough etiological evaluation. Larger abscesses were more likely to have detectable pathogens. Streptococcus was the most common pathogen; however, there was no significant correlation between abscess size and Streptococcus infection, suggesting that its pathogenic potential is similar to that of other bacteria. Conclusion and Significance This study emphasizes the importance of timely surgical drainage, individualized antimicrobial therapy, and etiological investigation, particularly for branchial cleft fistulas, in managing DNSA.

Introduction: Fetal oropharyngeal teratoma, or epignathus, is an extremely rare congenital malformation that represents less than 2% of congenital teratomas. Its main clinical relevance lies in the risk of complete obstruction of the fetal airway and perinatal death. Reported cases are typically diagnosed in the third trimester or at birth; however, ultrasound detection in the second trimester remains exceptional. This case provides evidence of early prenatal diagnosis of an epignathus with intrauterine demise in a resource-limited setting. Case presentation: A 20-year-old primigravida with prenatal care beginning at nine weeks presented at 27.2 weeks with rapid abdominal enlargement and a sensation of abdominal tension. Structural ultrasound revealed a heterogeneous oropharyngeal mass measuring 7.5 × 5.7 cm, associated with severe polyhydramnios, pleural effusion, ascites, and nonimmune fetal hydrops. No fetal heart rate was detected. Differential diagnoses included lymphangioma, branchial cleft cyst, rhabdomyosarcoma, and anterior encephalocele, with a presumptive diagnosis of oropharyngeal teratoma (epignathus). Labor induction was performed using 25 µg of vaginal misoprostol every 4 hours, resulting in the delivery of a female fetus weighing 700 g with a 6 × 6 cm oropharyngeal mass causing complete airway obstruction. The mother had a favorable postoperative course without complications. Conclusion: Early prenatal diagnosis of oropharyngeal teratoma is essential for planning care in specialized centers capable of advanced perinatal management. This case is unique due to its second-trimester diagnosis and comprehensive ultrasonographic correlation, contributing valuable information to the existing medical literature. The key takeaway is that timely sonographic suspicion, even in resource-limited settings, allows for diagnostic orientation, genetic counseling, and the provision of comprehensive and compassionate care in the setting of adverse fetal outcomes.

Branchial cleft cysts are congenital lateral neck masses which manifest in the adolescents or in adulthood. They arise from the remnants of the branchial apparatus of embryonic life. Cystic remnants present commonly in the adolescence. Second branchial cleft cysts are the most common form of the branchial anomalies and originate from the remnants of the cervical sinus of His and its duct during the differentiation of branchial apparatus. Purpose of the study was to report a case of second branchial cleft cyst in adolescent. Patient was presented with second branchial cleft cyst at the age of 20 years. Computed tomography of neck showed well-circumscribed cystic lesion with an internal solid component in the peri vertebral space extending to the left submandibular space at the level of lower cervical region, attached to left sternocleidomastoid muscle causing minimal displacement of left internal and external carotid arteries medially and left internal jugular vein laterally, suggesting branchial cleft cyst. Complete surgical excision of the cyst had been done. The histopathologic study revealed a squamous epithelium-lined cyst with lymphoid infiltration, consistent with branchial cleft cyst. The patient was discharged without any complications. Clinical manifestations combined with knowledge of the embryology and spatial anatomy of the head and neck provide clues for a correct diagnosis and appropriate management of branchial cleft cyst.

Cervical schwannomas are rare benign tumors that can present a significant diagnostic challenge, particularly when they exhibit cystic changes that mimic more common lesions such as second-branchial cleft cysts. We report the case of a 36-year-old male who presented with a gradually enlarging, firm, nontender neck mass. Imaging studies, including ultrasound and contrast-enhanced computed tomography, suggested a cystic lesion, most likely a second branchial cleft cyst. Fine-needle aspiration cytology was inconclusive. Surgical excision was undertaken, and histopathological examination revealed a schwannoma with areas of cystic degeneration. Immunohistochemistry demonstrated strong diffuse positivity for S100 protein, confirming the diagnosis. Postoperatively, the patient had an uneventful recovery without neurological deficits. This case highlights the importance of considering cervical schwannoma in the differential diagnosis of cystic neck masses and underscores the essential role of histopathology and immunohistochemistry in establishing an accurate diagnosis. Early recognition and complete surgical excision are key to achieving favorable outcomes.

Background: Branchial cleft cysts (BCCs) are congenital epithelial cysts resulting from developmental anomalies of the branchial apparatus. Type IV BCCs are extremely rare, especially in children. Case Presentation: We report the case of an 11-year-old male presenting with a right-sided neck swelling for 1.5 years and foreign body sensation in the throat for 1 year. Clinical and radiological evaluation confirmed a large Type IV branchial cleft cyst causing significant airway compression. The cyst was excised via a transcervical approach following elective tracheostomy. Postoperative recovery was uneventful, and histopathology confirmed the diagnosis. Conclusion: Type IV branchial cleft cysts are rare in the pediatric population. Accurate diagnosis through imaging and meticulous surgical excision are essential for optimal outcomes and prevention of recurrence.

Branchial cleft cyst, also known as a benign lymphoepithelial cyst, is a congenital disorder with an unclear pathogenesis. It most commonly occurs in the anterior triangle of the neck along the upper third of the sternocleidomastoid muscle, while occurrences at other sites are exceedingly rare. Diagnosis through ultrasound, computed tomography, or magnetic resonance imaging is challenging. Endoscopic submucosal dissection (ESD) enables the acquisition of complete specimens, aiding in the diagnosis and treatment of such lesions. This study presents a case of an esophageal branchial cleft cyst that was successfully diagnosed and treated with ESD, resulting in an excellent postoperative outcome. This case enhances clinical recognition of this rare entity and demonstrates the therapeutic utility of ESD in its management.

We present an unusual type I congenital first branchial cleft anomaly (CFBCA) characterized by a distinct sinus tract in the superior wall of the cartilaginous external auditory canal (EAC), classified as the sinus variant of type I congenital first branchial cleft anomalies (CFBCAs). This study aims to characterize its distinctive clinical features and present management approaches for this rare entity. Medical records of patients undergoing excision for sinus variant of type I CFBCAs between January 2007 and September 2023 (a 16-y period) were retrospectively analyzed. Clinical characteristics, therapeutic interventions, histopathologic diagnoses, and long-term outcomes were systematically catalogued. The sinus variant of type I CFBCAs is a rare manifestation of CFBCAs, accounting for 11 of 188 cases (5.9%) in our series. Cardinal clinical features included recurrent periauricular inflammation (9/11 cases, 81.8%), with all cases demonstrating a characteristic concealed sinus orifice at the superior cartilaginous EAC (11/11 cases, 100%). All patients (11/11 cases, 100%) were initially misdiagnosed as lymphadenitis, epidermal cysts, or localized infections. The concealed sinus orifices at the superior cartilaginous EAC were frequently overlooked, with definitive diagnosis established by visual inspection in only 3 patients (3/11 cases, 27.3%). In the remaining 8 patients (8/11 cases, 72.7%), occult sinus orifices were identified through combined palpation and visual inspection. All lesions originated exclusively from the superior cartilaginous EAC (11/11 cases, 100%) and maintained a relative simple relationship with the facial nerve trunk (11/11 cases, 100%). Complete surgical excision of the sinus tract along with any adherent periauricular cysts was determined to be the optimal treatment approach. Clinicians should maintain a high index of suspicion for the sinus variant of type I CFBCAs when evaluating pediatric patients with recurrent preauricular inflammation. The identification of a characteristic sinus orifice at the superior cartilaginous EAC during focused examination is diagnostic. Level 4.

Bilateral branchial cleft fistulas are extremely rare congenital anomalies that may be part of a larger syndromic association. Prompt recognition and treatment are crucial in syndromic patients to halt disease progression, improve outcomes, and reduce the risk of long-term complications. Complete surgical excision is the standard treatment for fistulas.

Chronic Non-Infected Branchial Cleft Cyst With Jugular Vein Displacement: Diagnostic and Surgical Challenges in a Rare Neck Mass

We hereby present a case of a 22-year-old female patient with a lesion on the right side of the uvula. Histopathological assessment identified a cystic lesion with a branching configuration. The cyst lining consisted of non-keratinising stratified squamous epithelium, ciliated columnar epithelium, and focal areas of mucinous columnar epithelium. Within the cystic lumen, a focus of ectopic parathyroid tissue was observed. Based on these findings, a final diagnosis of a uvular branchial cleft cyst containing ectopic parathyroid tissue was established. Pathological lesions of the uvula are rare, and cystic lesions typically correspond to epidermoid cysts. This case, therefore, represents the first documented occurrence of a uvular branchial cleft cyst containing ectopic parathyroid tissue, underscoring the importance of detailed histopathological and immunohistochemical evaluation in the assessment of even small, incidentally detected uvular lesions.

Objective:To summarize the clinical characteristics and management experience of complications in patients with cervical necrotizing fasciitis （CNF） with or without descending necrotizing mediastinitis （DNM）, in order to provide a basis for optimizing diagnosis and treatment strategies. Methods:A retrospective analysis was conducted on the clinical data of 31 patients diagnosed with CNF and DNM at Shandong Provincial Hospital Affiliated to Shandong First Medical University between October 2019 and March 2024. A comprehensive evaluation was performed based on the patients' clinical characteristics, metagenomic next-generation sequencing （mNGS） pathogen detection results, imaging assessments, surgical interventions, management approaches for specific complications, and prognostic outcomes. Results:Among the 31 patients, 10 had severe diabetes mellitus. Etiological analysis was summarized as follows: 5 cases were odontogenic, 3 were of tonsillar origin, 3 were due to endogenous esophageal injury, 2 were due to exogenous cervical trauma, 2 originated from a congenital branchial cleft fistula, and 16 cases had an unknown etiology. Among them, 29 patients underwent surgery via an external cervical approach, 1 patient underwent surgery via an intraoral approach, and 1 patient received ultrasound-guided puncture and drainage therapy. Ultimately, 29 patients were cured and discharged （including 1 patient who experienced two instances of major neck vessel rupture and successfully underwent two interventional embolization procedures for hemostasis）; 2 patients died after failed rescue efforts due to concurrent sepsis and multiple organ dysfunction. The treatment success rate was 93%, and the mortality rate was 7%. In this cohort of CNF and DNM cases, only a minority had a clearly identified odontogenic cause; although the etiology was unknown in most cases, imaging consistently showed oropharyngeal lymph node necrosis, suggesting a possible pharyngeal origin of infection in adults. The mNGS pathogen profile was predominantly Gram-positive bacteria, accompanied by anaerobic bacilli and fungi. Conclusion:CNF and DNM are severe and rapidly progressive conditions that can lead to life-threatening complications within hours. Timely recognition can reduce unnecessary examinations and expedite treatment.

Introduction: Cystic lesions of the pediatric head and neck encompass a broad spectrum of congenital, inflammatory, and neoplastic conditions, with the majority being benign. Accurate diagnosis is essential as clinical presentation often overlaps, while management strategies vary significantly. This paper reviews the embryological background, clinical features, radiological characteristics, and differential diagnosis of common pediatric cystic lesions, including thyroglossal duct cysts, branchial cleft cysts, dermoid and epidermoid cysts, cystic hygromas, plunging ranulas, and cervical thymic cysts. This case series aims to describe the radiological features of pediatric cystic neck lesions and to highlight their differential diagnosis to avoid misdiagnosis. Case description: A case series of five pediatric patients is presented, each illustrating characteristic imaging findings confirmed with computed tomography (CT) and magnetic resonance imaging (MRI). Key diagnostic considerations include patient age, lesion location (midline vs. lateral), history of infection, and radiological features such as cyst wall thickness, septation, and enhancement patterns. Conclusion: Ultrasound serves as the first-line imaging modality to differentiate cystic from solid masses, while CT and MRI provide superior anatomical delineation and staging. Recognition of these imaging features is critical for guiding diagnosis, avoiding misinterpretation as malignancy, and determining appropriate surgical or conservative management.

Fistulograms for the management of recurrent and atypical congenital neck anomalies.

Anatomical study of the superficial cervical plexus targeted for sensory nerve blocks in neonates.