Branchial anomalies: A review of 52 cases

Abstract

Fifty-two patients with branchial anomalies (BA) treated at the Children's National Medical Center between 1983 and 1993 were reviewed to determine the incidence of different types of anomalies and to analyze the authors' method of diagnosis and management. First BA was seen in 25%, second in 40%, third in 8%, and fourth in 2%. In 25%, the origin of the anomaly was undetermined. Our incidence of first BA was significantly higher than the incidence reported in other series. Of the anomalies, sinuses were more common than cysts or fistulae. Sinuses tend to present at an earlier age than cysts, which take time to enlarge and present clinically. Repeated incision and drainage and incomplete excisions were frequently seen with first, third, and fourth anomalies due to misdiagnosis. Recent trend has been to utilize radiographic studies more frequently, and they have been found to be helpful in guiding surgical therapy, particularly with the more complicated cases.

Anomalies of branchial cleft: our experience and review of literature

“…2,7 Choi and Zalzal have reported a maximum incidence of sinuses, followed by fistula. 1,6 In this study, majority of patients presented as discharging sinuses (26/30).…”

“…Amongst these, the widely accepted theory is that branchial anomalies develop as a result of incomplete involution of the branchial apparatus. 1,6,7 Most branchial arch anomalies arise from the second branchial cleft (92.45%). 1,8 Anomalies of first arch remnants (4.72%), third (1.87%) and fourth arch anomalies (0.94%) are quite rare [d].…”

Manejo endoscópico de anomalías del cuarto arco branquial: Reporte de tres casos

“…Otra forma frecuente de presentación clínica es mediante un cuadro de tiroiditis aguda supurativa. Taylor y cols 16 reportaron que 83% de los casos de tiroiditis aguda supurativa son izquierdos, 66% de ellos ocurrió tras una infección de vía respiratoria alta y 39% recurrió tras el tratamiento 17 ; esto ha sido motivo de recomendación de estudio de anomalías de hendidura branquial en todos los casos de tiroiditis aguda supurativa 18,19 . Aproximadamente 83% a 97% de las anomalías de cuarto arco branquial son izquierdas 4,16 .…”

Cysts of the Second Branchial Cleft: Case Report and Surgical Notes

“…The branchial apparatus begins to develop during the second week of gestation and the formation is completed between the sixth and seventh week of fetal life, and probably in this period may be some alterations in the maturation process that lead to the abnormalities of the branchial apparatus [3]. Several theories on the formation of branchial apparatus abnormalities (cervical thymus-pharyngeal theory, the included theory [4]) have been developed, but the most accepted theory is the evolution of the incomplete branchial apparatus [5]. Branchial cysts have equal prevalence in both sexes, and the average age at diagnosis is between the second and fourth decade [6][7][8] and only 2-3% of cases are bilateral and rare lymultiple [9].…”

“…In the case of infected cysts it is necessary to subject the patient to anti-inflammatory and antibiotic therapy, and after four weeks it is possible to perform the surgery, burdened by the formation of post-inflammatory fibrotic tissue [5].…”