Relation between a first branchial cleft anomaly and the facial nerve

An Effective Surgical Approach for the Management of Recurrent First Branchial Cleft Fistula with Cysts: A Case Report

“…Correct diagnosis and appropriate surgical intervention are important to minimize the incidence of recurrence and injury to the FN [7,8] because the relationship of the tract of the FBCA and the FN is usually intimate [9], especially in our case who had undergone previous multiple surgeries. In general, based on preoperative assessment, both MRI and computed tomography (CT) are useful to define the lesions, but anecdotally MRI appears to be more sensitive and specific [1,3] .…”

“…Based on the MRI signal and clinical presentation, we considered that our case should be classified as a first branchial cleft fistula with cysts. Traditionally, surgical removal of FBCA will involve either superficial or total parotidectomy with injury to the FN [9] . Intraoperatively, it is necessary to completely expose the FN for a safe total excision because the lesions can be variably associated with the nerve [9,10] .…”

“…Traditionally, surgical removal of FBCA will involve either superficial or total parotidectomy with injury to the FN [9] . Intraoperatively, it is necessary to completely expose the FN for a safe total excision because the lesions can be variably associated with the nerve [9,10] . Several approaches to identify the FN have been described in the literature: (1) directly identifying the main trunk of the FN between the posterior belly of the digastric muscle and the anterior wall of external auditory canal, and (2) identifying the mandibular marginal branch of the FN at the lower jaw.…”

Branchial cleft and pouch anomalies in childhood: a report of 50 surgical cases

“…A correct diagnosis will lead to proper management: complete surgical excision is the treatment of choice of branchial anomalies [11,35,36]. The first branchial cleft anomalies and facial nerve present a relation which can be classified into three types: superficial, deep to the facial nerve, or between the branches of the nerve [39]. D'Souza et al [24] reviewed a total of 158 cases and point out that lesions in younger patients were more likely to be deep to the facial nerve.…”

“…D'Souza et al [24] reviewed a total of 158 cases and point out that lesions in younger patients were more likely to be deep to the facial nerve. Guo et al [39] recommend that the suitable time for operation for first branchial cleft anomalies is over the age of 4 years, since the facial nerve has matured and the risk of facial palsy is lower. Regarding our study, 54.5 % of patients presented a first branchial cleft lesion deep to the facial nerve, whereas in 45.5 % of patients the anomaly was superficial; in 36.4 % of cases, the age of surgery was younger than 4 years old.…”