First Branchial Cleft Anomaly: Clinical Insight into its Relevance in Otolaryngology with Pediatric Considerations

Abstract

First branchial cleft anomalies (FBCA) represent a small subset of congenital malformations in neck. Prime objective of this study is to share our experience with FBCA, emphasize its relevance in otolaryngology and deal with its pediatric perspective. Embryology, pathologic anatomy and varied spectra of clinical presentations of FBCA are discussed. Along with this we have illustrated three different cases; all of them were of pediatric age group and were misdiagnosed by their treating specialists elsewhere. In this article we have also laid special emphasis on its pediatric considerations. FBCA are mostly misdiagnosed due to their unfamiliar clinical signs and symptoms. Swellings may masquerade as other neck masses. Majority of patients give a history of previous incision and drainage. While dealing with pediatric patients the important factors to be kept in mind are the age of child, superficial course of facial nerve, any associated agenesis of parotid gland. Alteration in surgical technique may be required in children. A thorough medical examination with high index of clinical suspicion should be kept in mind while dealing with such anomalies. Owing to their complex presentation and close relation with facial nerve they are challenging lesions for surgeons.

First Branchial Cleft Anomalies: Managing Various Cervico-Facial Anomalies and Otologic Malformations at a large Canadian Referral Centre

“…DOI: http://doi.org/10.17352/2455-1759.000044 all branchial cleft malformations; however, making them exceedingly rare [1]. They tend to present as a cyst, sinus, or fi stula occurring in a region known as Pochet's triangle, which is bounded by the external auditory canal superiorly, the mental region anteriorly, and the hyoid bone inferiorly [2]. Symptoms include drainage from a pit-like depression in this region, submandibular adenitis, a parotid mass, or otorrhea.…”

“…Symptoms include drainage from a pit-like depression in this region, submandibular adenitis, a parotid mass, or otorrhea. 10% of lesions are also associated with an asymptomatic membranous attachment between the tympanic membrane and fl oor of the external auditory canal [2,3]. These lesions are not to be confused with pre-auricular sinuses, which by defi nition are superfi cial to the fi rst branchial cleft (and were excluded from this study).…”

Imaging Evaluation of Pediatric Parotid Gland Abnormalities

“…fistulas (1). They are classified as type I or type II, depending on whether they are confined only to the membranous external auditory canal (type I) or occur primarily near the angle of the mandible, with the tract extending through the parotid gland toward both the membranous and cartilaginous external auditory canal (type II) (13,14).…”

A two-year-old with a duplicated external auditory canal; a first branchial cleft anomaly

“…First branchial cleft anomalies (FBCA) are less common: they account for <8% of all branchial anomalies [4][5][6]. The annual incidence is largely unknown and has been cited as 1 per 1,000,000 [7]. Because first branchial cleft anomalies are uncommon, recognizing them can be difficult and they are often misdiagnosed [8].…”