• Advances in pediatric surgery
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• v.8 no.2
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• pp.107-112
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• 2002

Branchial anomaly is a frequently occurring congenital abnormality in childhood. It is important for the pediatric surgeon alike to be familiar with the embryology and differentiation of head and neck structure to accurately diagnose and treat these lesions. Eighty-five patients with branchial anomaly treated at Hanyang University Hospital between 1980 and 2001 were reviewed to determine relative frequency, clinical classification and appropriate treatment. The male to female ratio of branchial anomaly was 1.2:1. The most commonly presenting age was before 1 year (32%) and the age group between 1 and 3 year (22%) followed it. According to the classification of branchial anomalies, 73 of 85 cases were second branchial anomaly, 9 had the first type and 3 did fourth type. One patient showed combined anomalies of the first and the second type. Infection sign were seen in 70% of patients at the time of the first visit to our hospital and also patients' symptoms were frequently related with the infection. Forty-one cases (48%) were fistula, 21 (25%) were cysts, 21 (25%) were sinuses, and two were only cartilage remnants. The most common type of the branchial anomalies is the second branchial fistula and the most common symptoms of the anomalies are related with infection. Initial proper diagnosis and anatomical classification of the anomalies are very important in managing the lesions. The efforts to find the exact anatomical location of the fistula or sinus tract are necessary because total excision of the lesions including those tracts is the only way to prevent recurrence.

• Korean Journal of Head & Neck Oncology
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• v.12 no.1
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• pp.22-25
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• 1996

A very important and interesting problem occasionally seen in the neck of children and adults is a branchial cleft anomaly. It is a rare congenital neck disease and presents a painless palpable mass of neck in most cases. We have retrospectively reviewed the medical records of 28 patients operated upon for branchial cleft anomaly at Department of Surgery, Chonnam University Hospital between January, 1991 and December, 1995. Three of these lesions were considered to have originated from the first branchial cleft, and 25 from the second branchial cleft. Females are about twice more common than male patients. Pathological findings showed the cysts were lined squamous epithelium and subepithelial lymphoid follicles in most cases. Five out of 28 patients with branchial cleft anomalies had previous incision procedures. All patients after complete removal of branchial anomalies have no recurrences.

• Advances in pediatric surgery
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• v.17 no.2
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• pp.162-169
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• 2011

Branchial cleft anomalies are the second most common head and neck congenital lesions seen in children. Amongst the branchial cleft malformations, second cleft lesions account for 95 % of the branchial anomalies. This article analyzes all the cases of second branchial cleft anomalies operated on at Seoul National University Hospital from September 1995 to February 2011. We analyzed sex, age, symptom and sign, accompanied anomaly, diagnosis, treatment, pathologic report and outcome via retrospective review of medical records. In this series, we had 61 patients (27 female and 34 male). The mean age at the time of operation was 38 months. 31 lesions were on the right, 20 were on the left and 10 were bilateral. The most frequent chief complaints at presentation were non-tender mass and cervical opening without any discharge. According to anatomic type, 29 patients had branchial cleft sinuses, 14 had cysts, 14 had fistulas and 4 had skin tags. Complete excision was attempted if possible and antibiotics challenged when infection was suspected. Complete excision was achieved in 96.7 % of cases. Incision and drainage was done in 2 cases due to severe inflammation, and both recurred. Postoperative complications included wound infection in 2 cases. Microscopic examonation revealed squamous epithelium in 90.2 % and squamous metaplasia in one case in the branchial cleft cyst wall. In summary, second branchial anomaly is found more frequently on right side of neck. Fistulas are diagnosed earlier than cystic forms. Most cases could be diagnosed by physical examination. The definitive treatment is complete excision and sufficient antibiotics coverage for cases with inflammation. After drainage of infected lesions, follow up excision after 1 year might be beneficial for preventing recurrence.

• Korean Journal of Head & Neck Oncology
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• v.21 no.1
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• pp.53-56
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• 2005

The branchial anomaly is a lateral neck mass commonly seen by otolaryngologists. Depending on its anatomic location, branchial anomaly can be classified into first, second, third and fourth. The fourth branchial cleft anomaly is very rare entity and until now, only 35cases have been reported worldwide. It may present as neck cyst, recurrent neck abscess, thyroiditis. Combined with barium swallow esophagogram and computed tomography scan can aid in diagnosis of this rare disease entity. Complete excision of the entire epithelial tract combined with ipsilateral thyroid lobectomy remains the mainstay of treatment. Authors experienced a case of lateral neck mass which was anatomically presumed to be the fourth branchial cleft cyst. We report this case with the related literature.

• Korean Journal of Head & Neck Oncology
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• v.10 no.2
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• pp.122-127
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• 1994

One hundred fifty four cases of branchial anomaly treated from January 1987 to July 1993 were analysed to determine clinical features, embryologic and anatomic types of the branchial cleft anomaly, to investigate the differences between adults and pediatrics, and to establish the appropriate treatment plan. The male to female ratio was not signifiacntly different in pediatric and adult patients. The mean symptom duration was 0.5 years(range 0.08-14 years) in pediatric patients and 1.67 years (0.7-7 years) in adult patients. The clinical presentations of these anomalies were lateral neck mass in 112(72.7%), infected discharge in 22(14.3%), non-infected discharge in 6(3.9%), and abscess in 14 cases(9.l%). Sites of the lesions were upper third of the neck in 93(60.3%), infraauricular in 35(22.7%), middle third of the neck in 17(11.0%) and inferior third of the neck in 9 cases(5.8%). The anatomic types were cystic form in 117(75.9%), sinus in 24(15.5%), and fistula in 13 cases(8.4%). Embryologic classification were 124 second branchial cleft anomalies(80.5%), 29 first branchial cleft anomalies(18.8%), and 1 third branchial cleft anomaly(0.6%). Immediate surgery under the uncontrolled infection in 17 cases result in 82.4% recurrent rate(14 cases), and 17.6% cure rate(3 cases). Delayed surgery under the controlled infection in 8 cases recurrent rate(1 case), and 87.5% cure rate(7 cases). In summary, the most common branchial cleft anomaly is second type cyst both in pediatric and adult group, delayed surgical exterpation after infection control with I & D or antibiotics may give a good chance for care and may reduce the recurrence.

• Korean Journal of Head & Neck Oncology
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• v.8 no.1
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• pp.6-13
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• 1992

Branchial apparatus anomaly is rarely encountered congenital neck disease, it presents a palpable non-tender mass or fistulous opening existed at any site from external auditory canal or mandible angle to lower part of neck We have reviewed the records of 50 patients operated upon for branchial cleft anomaly, at Department of Surgery, Inje University Hospital, between 1981 and 1990, and the following results were obtained. I) In the classificiation of branchial cleft anomaly, first branchial fistula was 1 case, second branchial cyst 32 cases, second branchial sinus 11 cases, second branchial fistula 5 cases and third branchial fistula 1 case. 2) There were 20 men and 30 women in this series and male to female ratio was 2:3. 3) The age at first clinical presentation was 1st decade 15 cases, 2nd decade 10 cases, 3rd decade 17 cases, 4th decade 5 cases and 5th decade 3 cases. The peak age incidence was 3rd decade in overall, but the cyst was most common in 2nd decade, and majority of sinus or fistula was seen below 10 years old age. 4) The prevalent side of this anomaly was right side in 19 cases, left side in 29 cases and bilateral 2 cases, and so left side was more common than right. 5) The clinical presentation was characterized by the lesion along anterior border of sternocleido muscle, non-tender palpable mass were 28 cases, drainage sinus 18 cases, recurrent abscess and drainage 5 cases and intermittent ear discharge 1 case. 6) The mean size of cyst was about 4cm that containing turbid white-yellowish fluid but discharge from sinus or fistula was clear mucoid. 7) The culture of cyst fluid was no bacteria, but 2 cases showed staphyloccoci suggesting secondary infection. 8) The surgical procedure were complete excision of cyst 32 cases, sinus excision 11 cases, fistula excision 6 cases and I&D 1 case. And the recurrent 1 case was that fistula tract could not be identified due to severe scar from previous several operations.

• Korean Journal of Head & Neck Oncology
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• v.25 no.1
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• pp.12-17
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• 2009

Background and Objectives : Branchial anomaly is a common neck pathology seen by otolaryngologist. Although there is still controversy regarding the origin, almost all surgeon agree that branchial anomalies result from incomplete involution of the branchial apparatus. Depending on its anatomic location, branchial anomalies can be classified into first, second, third and fourth anomaly. The purpose of this study is to evaluate the incidence of different categories of branchial anomalies and to determine proper method of diagnosis and treatment. Subjects and Method : A retrospective chart review was conducted for 72 patients with branchial anomalies operated on at the Korea University Anam Hospital from 1996 to 2007. The patient's sex, age, presenting symptoms, classification, site of lesion, diagnostic studies, surgical therapy and post-operative surgical complication were reviewed. Results : Patients were commonly seen in the 3rd decades. Eleven patients(15.3%) were first branchial anomalies, 52(72.2%) were second, 1(1.4%) was third, and 8(11.1%) were fourth. Of the types of anomalies, cyst were most commonly seen. In cases of 3rd and 4th branchial anomalies, barium contrast study can delineate the course of sinus or fistula. All cases was operated on for branchial anomalies, there were no major post-operative complication. Conclusion : Cervical mass and recurrent cervical infection or abscess are suspect for branchial anomalies. Especially, clinical history of dysphagia, and recurrent painful swelling in the thyroid region in young patients should raise the suspicion of 3rd and 4th branchial anomalies. Careful history, clinical examination and radiographic study were essential parts in diagnosis of branchial anomalies. Although surgical management of branchial anomalies depend on its type, nature and extent, complete excision is the major surgical procedure.