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Diagnosis and treatment of branchial cleft anomalies in UKMMC: a 10-year retrospective study

  • Head and Neck
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European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Branchial cleft anomalies result from abnormal persistence of branchial apparatus, which is located at the lateral part of the neck. These occur due to failure of obliteration of the branchial apparatus during embryonic development. Differential diagnoses of lateral neck mass are salivary gland or neurogenic neoplasms, paragangliomas, adenopathies, cystic hygroma or cystic metastasis from squamous cell carcinoma or thyroid papillary carcinoma. Clinically, a branchial cyst is smooth, round, fluctuant and non-tender, and usually occurs over the upper part of the neck, anterior to the sternocleidomastoid muscle. Sometimes, it may present as infected cyst (or abscess), a sinus or fistula. Surgical excision is the definitive treatment for branchial anomalies. The objective of the work was to study the demographic data, clinical presentation, definite diagnostic workup and treatment of patients diagnosed with branchial anomalies. This is a retrospective study of 26 patients who were diagnosed with branchial anomalies (branchial cyst and fistula), of which only 12 patients had data available between July 1999 and June 2009 at the Otorhinolaryngology, Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre. Twelve cases of branchial anomalies were seen, in which 10 patients had second branchial cyst anomalies, 1 had third branchial fistula and 1 had bilateral branchial lesion. There were seven females and five males. The age of the patients varied over a wide range (4–44 years), but the majority of the patients were in their second and third decade of life. All branchial anomalies occurred at the classical site; eight patients had left-sided neck lesion. Correct clinical diagnosis was made only in five patients (41.6 %). All patients underwent surgical excision with no reported recurrence. Branchial anomalies are frequently forgotten in the differential diagnosis of lateral neck swelling. Diagnosis is usually delayed, leading to improper treatment. The diagnosis of patients who present with lateral neck cystic swelling with or without episodes of recurrent neck abscess should be considered with a high suspicion for branchial anomalies. FNA cytology is a good investigative tool in reaching toward a diagnosis of branchial lesion, with the concurrent assistance of radiological modalities. Surgical excision is the gold standard treatment of lesions of branchial anomalies.

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References

  1. Golledge J, Ollis H (1994) The aetiology of lateral cervical (branchial) cyst: post and present theories. JLO 108:653–659

    Article  CAS  Google Scholar 

  2. Wenglowski R (1912) Ueber die Halsfisteln und Cysten. Langenbeck. Arhiv fur Klinische Chirurgie 98:151–208

    Google Scholar 

  3. Bhaskar SW, Beernier JL (1959) Histogenesis of branchial cysts: a report of 468 cases. Am J Pathol 35:407–414

    PubMed  CAS  Google Scholar 

  4. Luschka H (1848) Ueber fistula colli congenital. Archiv fur Physiologische Heilkunde 7:25–27

    Google Scholar 

  5. Houck J (2005) Excision of branchial cyst. Oper Tech Otolaryngol 16:213–222

    Article  Google Scholar 

  6. Agaton-Borila FC, Gey-Escudo C (1996) Diagnosis and treatment of branchial cleft cyst and fistula. A retrospective study of 183 patients. Int J Oral Maxillofac Surg 25:449–452

    Article  Google Scholar 

  7. Work WP, Proctor CA (1963) The otologist and first branchial cleft anomalies. Ann Otol Rhinol Laryngol 72:548–562

    PubMed  CAS  Google Scholar 

  8. Work WP (1972) Newer concepts of first branchial cleft defects. Laryngoscope 82:1581–1593

    Article  PubMed  CAS  Google Scholar 

  9. Choi SS, Zalzal GH (1995) Branchial anomalies: a review of 52 cases. Laryngoscope 105:909–913

    Article  PubMed  CAS  Google Scholar 

  10. Ford GR, Baladrishnan A, Evans JNG et al (1992) Branchial cleft and pouch anomalies. J Laryngol Otol 106:137–143

    Article  PubMed  CAS  Google Scholar 

  11. Dhingra PL, Dhingra S (2010) Disease of ear, nose and throat. 5th edn. pp 88, 399–400

  12. Som PM, Smolev WRR, Curtin HD (2003) Congenital lesion of the neck. In: Som PM, Curtin HD (eds) Head and neck imaging. Mosby-Year Book, St Louis, pp 1828–1864

    Google Scholar 

  13. Sobol SM (1987) Branchial cleft remnants. In: Thaoly ST, Panje WR (eds) Comprehensive management of head and neck tumours, vol II. WB Saunder, London, pp 1353–1363

    Google Scholar 

  14. Daoud Faeiz S (2005) Branchial cyst. An often forgotten diagnosis. Asian J Surg 3:174–178

    Article  Google Scholar 

  15. Moore K (1988) The developing human. The clinical oriented embryology. WB Saunders, Philadelphia

    Google Scholar 

  16. Kenealy JF, Torsiglieri AJ Jr, Tom LW (1990) Branchial cleft anomlies: a five-year retrospective review. Trans Pa Acad Ophthalmol Otolaryngol 42:1022–1025

    PubMed  CAS  Google Scholar 

  17. Smith OD, Ellis PD, Bearcroft PW et al (2000) Management of neck lumps—a triage model. Ann R Coll Surg Engl 82:223–226

    PubMed  CAS  Google Scholar 

  18. Maran AGD, Buchanad DR (1978) Branchial cyst, sinuses and fistulae. Clin Otolaryngol 3:77–92

    Article  PubMed  CAS  Google Scholar 

  19. Wilson CP (1955) Lateral cyst and fistulae of the neck, of developmental origin. Ann R Coll Surg 17:1–26

    CAS  Google Scholar 

  20. Hung SC, Ling FW, Feng YC et al (2007) Branchial cleft cyst as the initial impression of a metastatic thyroid papillary carcinoma: two case reports. Kaohsiung J Med Sci 23(12):634–638

    Article  Google Scholar 

  21. Skoutiers CA, Patterson GT, Sotereanos GL (1989) Benign cervical lympho-epithelial cyst: report of cases. J Oral Maxillofac Surg 47:1106–1112

    Article  Google Scholar 

  22. Vannineuse A (1976) Les. Kystes et fistules branchiaux latero-cervicaux. Acta Otorhinolaryngol Belg 30:299–307

    PubMed  CAS  Google Scholar 

  23. Regauer S, Gogg-Kamerer M, Braun H, Beham A (1997) Lateral neck cyst—the branchial theory revised. A critical review and clinicopathologic study of 97 cases, with special emphasis in cytokeratin expression. APMIS 105(8):623–630

    Article  PubMed  CAS  Google Scholar 

  24. McClure MJ, McKinstry CS, Stewart R, Madden M (1998) Late presentation of branchial cyst. Ulster Med J 67:129–131

    PubMed  CAS  Google Scholar 

  25. Anand TS, Tatavarty Shashidhar, Pal Swatilika, Chabra Ekta, Kumar Saumita (2007) Oropharyngeal branchial cleft cyst. Int J Paed Otorhinolaryngol 2:222–224

    Article  Google Scholar 

  26. Diaz-Manzano JA, Sanchez-Martinez N, Iniesta-Alcazar J, Medina-Banegas A (2008) Conservative surgical treatment of pharyngeal branchial cyst. Auris Nasus Larynx 35:161–164

    Article  PubMed  Google Scholar 

  27. Chandler JR, Mitchell B (1966) Branchial cleft anomalies: a review of 87 cases treated at the Toronto General Hospital. Can Med Assoc J 94:174–179

    Google Scholar 

  28. Marrakachi R, Romdhane KB, Kharrat N, Sioud H (1989) Les anomalies de la premiere fente branchiale. A propos de 3 observations. Rev Stomatol Chir Maxillofac 90:52–57

    Google Scholar 

  29. Guerrier B, Guerrier Y, Charlin B (1978) Kystes et fistules de la premiere fente branchial. A propos de quatre cas. cah. ORL 10:979–988

    Google Scholar 

  30. Churchill P, Otal D, Pemberton J, Ali A, Flageole H, Walton JM (2011) Sclerotherapy for lymphatic malformations in children: a scoping view. J Paediatr Surg 46:912–922

    Article  Google Scholar 

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Conflict of interest

All authors declare that they have no conflict of interest in term of financial contribution for this research.

Ethical standard

All individuals gave their informed consent prior to their inclusion in the study. All human studies have been approved by the appropriate local ethics committee and were performed in accordance with the ethical standards as originally laid down in the 1964 Declaration of Helsinki and updated in October 2001.

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Correspondence to Syed Zaifullah.

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Zaifullah, S., Yunus, M.R.M. & See, G.B. Diagnosis and treatment of branchial cleft anomalies in UKMMC: a 10-year retrospective study. Eur Arch Otorhinolaryngol 270, 1501–1506 (2013). https://doi.org/10.1007/s00405-012-2200-7

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  • DOI: https://doi.org/10.1007/s00405-012-2200-7

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