First branchial cleft anomalies in children: Experience with 30 cases

Abstract

First branchial cleft anomalies (FBCA) are rare in the clinical setting, as they account for 1 to 8% of all branchial abnormalities. The purpose of this study is to explore the relationship between the fistula tract and facial nerve and the surgical method of FBCA. This retrospective study included 30 cases of FBCA in children managed from 2009 to 2016. All patients underwent surgery to remove the tract of the FBCA. We reviewed the clinical data of the patients to obtain their demographics and management. Thirty patients (11 male and 19 female) with anomalies of FBCA were diagnosed. The ages ranged from 1 to 13 years (median, 3 years). Twenty cases had a close relationship with the parotid gland. The facial nerve was identified in 20 of the 30 patients. The tract ran deep to the facial nerve in 3 cases, superficial to it in 21 cases, and passed between the branches of the nerve in 6 cases. The facial nerve was not identified in ten patients, as the tract was superficial to it. There were 2 cases of postoperative temporary facial paralysis (2/30, 6.7%). The symptoms gradually improved after one month, 1 case had permanent facial paralysis (1/30, 3.3%), and 1 case had postoperative recurrence. Complete excision of the tract is the only way to manage FBCA, and the course of the tracts vary and have different relationships with the facial nerve. There are 3 types: Superficial, deep to the facial nerve, and between the branches of the nerve. Therefore, surgical approaches differ among the various types, and careful preoperative planning and protecting the facial nerve during resection of the tract are essential.

Unusual coexistence of first and second branchial fistulas: clinical case and review of the literature

“…The annual incidence of first branchial fistulas is reportedly 1 per 1,000,000 individuals, and the incidence is higher in women than men. 6 A branchial fistula with a thyroglossal duct cyst has been occasionally reported in the literature. 7 The coexistence of two types of branchial fistulas on the same side has been rarely reported.…”

Anomalies of the branchial arch apparatus in children: case series and review of literature

“…20 FBCA, they can present as cystic mass or discharging pit in the Pochet's triangle area which consists of the EAC, the hyoid body and the mandibular angle and are more common on the left side. 19,21 The lesion is easily misdiagnosed and usually present repeatedly with swelling, pain and purulent discharge from the skin opening. Preauricular sinuses, epidermal cysts, dermoid cysts, mastoid abscess, postauricular lympadenopathy and parotid lesion all can mimic FBCA.…”

“…20 Contrast enhanced CT and magnetic resonance imaging help in exact localization of lesion and its relation with facial nerve, parotid gland and EAC. 20,21 Several authors have proposed classifications to assist appropriate diagnosis and management of these lesions. In 1971, Arnot classified FBCA into two types according to anatomical site: type I presents as a defect in the parotid region and seen in early or middle adult life, whereas type II defects are encountered during childhood in the anterior cervical region.…”

“…16 The course of the tract varies and has variable relationship with the facial nerve-superficial, deep to the nerve or between the branches of the nerve. 19,20,21 Thus, facial nerve is always at risk during the surgical removal of FBCA. 25 The risk of facial nerve palsy is higher in patients having recurrent infections and inadequate treatment (incision, drainage or incomplete excision).…”

Atypical first branchial cleft fistula: A case report

“…Duplication or failure of obliteration of the embryologic tract is the likely etiology of these lesions [ 3 ]. During development, the closure time of the cleft is concurrent with the migration of the facial nerve and emergence of the developing parotid gland, which originates from the second branchial arch; thus, FBCA have a close relationship between these structures [ 4 ].…”