Key points:
- Branchial cleft anomalies (BCA) occur as sinuses, fistulas or cysts,
arising mostly from the second branchial cleft represent 40-95%
- To effectively treat second, third and fourth cleft BCA, total
surgical excision is recommended
- A strict differentiation between sinuses, cysts or fistulae is
necessary to guarantee the optimal choice of surgical technique and
approach
- In the existence of residual tracts leading to the tonsillar fossa,
beside the need of extirpation of the tract itself, the necessity of
ipsilateral tonsillectomy to prevent recurrence is discussed
- After total excision BCA recurrency-rates ranges from 0 to 4% and
within our data recurrency occurred 1,25%, with no clarity due to the
necessity of tonsillectomy
1 Introduction
During the embryological development, in the fourth week of gestation,
six pairs of arches, clefts and pouches form the branchial or pharyngeal
apparatus. Every arch consists of a cartilaginous element, muscular
component, a corresponding branch of the aortic arch and a cranial
nerve. These components later form various structures in the head and
neck and due to non-fusion or subinvolution can result in branchial
cleft anomalies (BCA).[1, 2] These BCA can occur as sinuses,
fistulas or cysts and are present at birth, although maybe symptomatic
until later in adulthood. [2, 3] BCA comprise about 20% of
congenital lesions in children and arise from the first, second, third
or fourth pharyngeal cleft [2]
Whereas first branchial cleft anomalies can be divided into Work type I
(preauricular and lateral to the facial nerve) and Work type II
(mandibular angle/submandibular and medial/or lateral to the facial
nerve), third branchial anomalies present in the middle and lower third
of the sternocleidomastoid muscle (SCM). The fourth BCA are extremely
rare (1%) and normally present in the middle portion of the SCM.[2]
BCA arising from the second pharyngeal cleft are the most common and
represent 40-95%. [2, 4] They are usually located in the lateral
neck anterior and medial to the SCM and can have contact to the
ipsilateral pharyngeal, explicitly the tonsillar region. [2, 4, 5]
The majority of BCA present as cysts between the age of 20-40, in
younger age (<5 years) sinuses and fistulas are more
common.[4]