Second Branchial Anomalies in Children

Abstract

Aim: The aim of this study was to evaluate the data of our patients who had been treated for second branchial anomalies in the last 10 years. Here we report our clinical experience in second branchial anomalies with a review of the literature. Patients and Methods: We evaluated retrospectively the data of 14 patients, who had been operated on between 1994 and 2004 for second branchial anomalies, in relation to age, sex, complaint at application, diagnostic test, surgical procedures and histopathologic findings. Results: The mean age of the patients (8 female, 6 male) was 5.3 years (range = 1.5–16). The anomalies were usually located on the left side of the neck (n = 6). There were only 3 cases with bilateral anomalies. The majority of the lesions were sinuses (93%). The most frequent clinical feature was the presence of persistent discharge from an external (cutaneous) orifice. All lesions were excised by performing a second step ladder incision. Eight of the lesions were removed under the guidance of 3/0 polypropylene suture. No postoperative complication or recurrence was observed during the follow-up period. Conclusions: Second branchial arches anomalies are the most common branchial anomalies. Sinuses are more frequently encountered in children. Definitive treatment for these lesions is surgical excision. A polypropylene suture can be inserted into the tract as a guide to prevent incomplete excision.

Second Branchial Anomalies in Children and Literature Review

“…The external and internal invaginations through the arches give rise to the development of internal endodermal pouches and external ectodermal clefts (1,2).Second branchial fistulas occur when caudal grow of the second pharyngeal arch over the third and fourth arches is interrupted, leaving the remnants of the second, third, fourth clefts in contact with the surface by a narrow canal (3,4). Branchial anomalies occur during embryological development as a result of incomplete obliteration of the branchial cleft, and manifest themselves as cyst, sinuses or fistulas in the neck region.…”

“…Branchial anomalies occur during embryological development as a result of incomplete obliteration of the branchial cleft, and manifest themselves as cyst, sinuses or fistulas in the neck region. The second branchial anomalies accounts for about 90% percent of all branchial anomalies which are usually located on the lateral side of the neck directly anterior to the superior one third of the sternocleidomastoid muscle (1)(2)(3). Almost 2% to 13% of the second branchial anomalies are bilateral (2)(3)(4)(5).…”

“…The second branchial anomalies accounts for about 90% percent of all branchial anomalies which are usually located on the lateral side of the neck directly anterior to the superior one third of the sternocleidomastoid muscle (1)(2)(3). Almost 2% to 13% of the second branchial anomalies are bilateral (2)(3)(4)(5). The course of the second branchial fistula begins from the external opening of the lesions, coursing cephalad along the lateral carotid sheath, passes between the internal and external carotid arteries and travels lateral to the glossopharyngeal, hypoglossal and superior laryngeal nerves.…”

“…The course of the second branchial fistula begins from the external opening of the lesions, coursing cephalad along the lateral carotid sheath, passes between the internal and external carotid arteries and travels lateral to the glossopharyngeal, hypoglossal and superior laryngeal nerves. After moving deep to the stylohyoid muscle, it pierces the upper border of the middle pharyngeal constructor to enter the tonsillar fossa (2,3,6). The second branchial cleft sinuses/cysts are classified into four types by Bailey.…”

“…But, it is adequate to reach a diagnosis by observing the external orifice and the discharge from the fistula. However, we think that it is needed to perform a CT or MR investigation in the patients with cervical mass to establish a definite diagnosis (3,6,8,10).…”