Branchial Cysts in Quito, Ecuador

Abstract

Introduction Branchial cleft anomalies are the second most common congenital anomaly in children. However, some lesions may not develop clinically and are not diagnosed until adulthood. The recent literature of branchial cysts (BCs) in the adult population is really scanty. For this reason, we analyzed the clinical and surgical management of the adult population treated for a BC at a tertiary care general hospital. Methods A retrospective review of the clinical records of all the patients with histological diagnosis of BC who were surgically treated at the Social Security Hospital in Quito, Ecuador, was performed. Fifty-one patients (27 women) with congenital anomalies of the 2nd (43 patients with cysts) and 3rd (6 patients with cysts and 2 with fistula) branchial arches were diagnosed and treated. Diagnosis was made on clinical grounds and by computed tomography scan. Results The 43 patients with a 2nd branchial cleft cyst underwent complete surgical excision through a wide mid-neck transverse cervicotomy. The 6 cases of 3rd branchial cleft cyst underwent surgical resection through a lower-neck transverse incision, and the 2 patients with clinical fistula in the lower aspect of the neck were operated on via an elliptical incision around this external fistula opening. Postoperative evolution was uneventful in all patients. Conclusions Branchial cysts can occasionally be diagnosed in adult patients in the setting of a general hospital population. A correct clinical and imaging assessment was diagnostic in most patients. Complete surgical resection was curative in all our patients, and postoperative complications were exceptional.

A Systematic Literature Review to Compare Clinical Outcomes of Different Surgical Techniques for Second Branchial Cyst Removal

“…Traditionally, conventional surgery using a large cervical incision was used to ensure complete removal. 10-31 However, the large cervical incision results in a prominent scar. In an attempt to reduce visible scars, newer techniques have been developed, such as endoscopic surgery 9,32-35 and the use of a retro-auricular hairline incision (RAHI).…”

An Atlas of Lumps and Bumps: Part 18

“…1,10 Branchial cleft anomalies may present as a sinus (Figure 1), cyst, fistula, or cartilaginous remnant (Figure 2), alone or in combination, in the lateral aspect of the neck anterior to the sternocleidomastoid muscle. 2,3,7,10,11 In one study, the most common presentation was a discharging sinus (59.25%) followed by a cystic neck swelling (33.3%). 12 A branchial cleft cyst typically presents as a nontender, mobile, and fluctuant mass located along the anterior border of the sternocleidomastoid muscle, usually just above the clavicle, although initially it may present as a visible punctum.…”

“…2 Persistence or incomplete obliteration of the cervical sinus of His accounts for the presence of a branchial cleft anomaly. 2,3 Branchial cleft anomalies account for approximately 40% of congenital neck masses and are the second most common cause of congenital neck masses in children, preceded only by thyroglossal cysts which account for approximately 43% of cases. 4 Gender distribution is similar for both male and female fetuses.…”

“…4 Gender distribution is similar for both male and female fetuses. 3,5,6 There is no racial predilection. 5,7 Branchial cleft anomalies occur more frequently in patients with a positive family history.…”

“…14 Secondary bacterial infection occurs in approximately 10% of cases and may result in abscess formation (Figure 3). 3,16 Occasionally, cystic compression of the upper airway may result in stridor and dyspnea. 5 The reported recurrence rate after surgical excision ranges from 3% to 7%.…”