Branchial Anomalies: A Retrospective Analysis in a Tertiary Care Hospital

Abstract

Branchial anomalies are the second most common congenital head and neck masses. Although congenital, all age groups are known to be affected. Branchial anomalies are common congenital pediatric head and neck lesions but are comprised by several diverse anomalies. Treatment must be tailored depending on which branchial arch is involved and whether a cyst mass or sinus/fistula tract is present. KEYWORDS: Branchial anomaly, branchial cleft cyst, branchial fistula, branchial sinus, congenital neck mass, pediatric neck mass INTRODUCTION: Branchial anomalies comprise approximately 20% of pediatric congenital head and neck masses, making them, after thyroglossal duct cysts, the second most common 1. Although the term branchial anomaly encompasses first, second, third and fourth branchial cleft cysts, sinuses and fistulae, all of which are distinct clinical entities and require separate management, all are thought to result from a similar embryologic error: incomplete obliteration of the branchial apparatus during embryogenesis 2. The branchial apparatus consists of six grooves (ectoderm), arches (mesoderm) and pouches (endoderm). When a pouch or groove fails to obliterate, it may communicate with either skin or mucosa of the upper airway, forming a sinus. When both a pouch and a groove fail to obliterate, it may form a communication between the skin and mucosa, which is termed a fistula. When a branchial groove remnant forms an epithelial-lined space without communication to the skin or mucosa, a cyst is formed 1. Each of the six branchial arches (with the exception of the fifth) develops into specific structures in the head and neck. A branchial anomaly and its associated tract typically lies inferior to all the derivatives of its associated arch and superior to all derivatives of the next arch 2. The malformations can, therefore, be divided into first through fourth branchial anomalies. PATIENTS AND METHODS: A retrospective analysis was conducted between Jan 2008 to June 2012, over a period of 54 months in KIMS Bangalore. Total number of 31 cases were analysed. RESULTS: First and second decade was the most common age group affected. (Chart 1). Eighty nine percent of patients were males. Right sided lesions were seen in 68% of patients, left in 22% and bilaterally in 10% of patients. Discharge from the external opening and swelling were the most common symptoms. (Figures 1, 2 and 3). Surgery was performed in all the patients. Elliptical incision was used in the majority of cases; step ladder incision was the next most common incision used. (Figure 4).