Selective Neck Dissection: A Novel Technique for Second Branchial Arch Anomalies

Raj, Sagaya; Mohiyuddin, Azeem; Mohammadi, Kouser; Merchant, Shuaib; Deo, R. P.; Nawaz, Samdani

doi:10.5005/jp-journals-10001-1182

Cited by 1 publication

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“…Fistulas are typically discovered in children or infants when fluid or purulent material drains from an opening at the sternocleidomastoid's anterior edge in the neck's lower one-third. Infection of the cyst or fistula tract can lead to pain, purulent discharge, and the spread of infection along tissue planes in the neck [ 7 ]. Computed tomography (CT) or magnetic resonance imaging (MRI) confirms the diagnosis, extent, and location of the anomaly, and its proximity to important neurovascular structures.…”

Section: Introductionmentioning

confidence: 99%

The Outcome of Treatment in Second Branchial Cleft Anomalies: A Case Series

Paul¹,

Mohiyuddin²,

Sagayaraj³

et al. 2023

Cureus

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Background Branchial-cleft anomalies are second only to thyroglossal duct anomalies among congenital malformations of the neck, and second branchial-cleft anomalies are the most common. These include branchial cysts, branchial sinuses, and branchial fistulas. Clinical symptoms include neck swelling and a discharging sinus or fistula opening. In a small number of cases, they can lead to major complications like abscesses or malignant changes. Surgical resection is the treatment of choice. Various approaches to resection and sclerotherapy have been tried. In this study, we present our treatment outcome with branchial cleft anomalies at a rural tertiary medical care hospital. Objectives To document the various presentations, clinical features, and outcomes of treatment with second branchial cleft anomalies. Methods This retrospective observational study included 16 patients operated on for second branchial-cleft anomalies. A detailed medical history was elicited, and an accurate clinical examination was done. A contrast-enhanced computed tomography (CECT) scan was done in all cases. A few cases required a fistulogram. The cysts, sinuses, or fistulas were resected en bloc by a single neck crease incision. Primary closure was done in all cases. A recurrence or pharyngocutaneous fistula required axial flap reconstruction. The complications and recurrences were documented. Result There were six children and 10 adults in our study. Seven cysts, five sinuses, and four fistulas were present, of which four were iatrogenic. In seven patients, imaging could not show the entire tract. There were four fistulas from the oropharynx to a cutaneous opening in the neck. A complete resection was done for all. Two pharyngocutaneous fistulas were treated with a pectoralis major myocutaneous (PMMC) flap. Three patients had wound dehiscence postoperatively. None of the patients had neurological or vascular injuries. Conclusion Second branchial cleft anomalies can be completely excised by a single neck crease incision. Meticulous surgery results in a low recurrence or complication rate. Following complete excision, in type IV anomalies, a purse-string suture at the pharyngeal opening ensures good closure and no recurrences.

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Section: Introductionmentioning

confidence: 99%