Congenital sternoclavicular dermoid sinus

Congenital Sternoclavicular Sinus-Case Series of a Rare Lower Neck Deformity

OBJECTIVES

We encountered patients with a congenital cutaneous sinus tract in the sternoclavicular joint region, which we designate as "congenital sternoclavicular sinus (CSCS)." The aim of this investigation is to enhance recognition of this subtle yet noteworthy entity and develop standardized protocols for its management.

PATIENTS AND METHODS

Between 2013 and 2023, 172 patients, including 78 males and 94 females, were referred to our institution for the management of CSCS. Clinical charts were retrospectively reviewed.

RESULTS

The majority of patients (60.5%) were young children below 3 years of age, with only six adult patients and a median age of 27.5 months. The left side was implicated in 157 cases (91.3%). In 146 cases (84.9%), a faint skin streak was noted above the orifice. Yet, no pharyngeal sinus tracts were detected, either through barium swallow studies or direct laryngoscopy. All skin lesions featured a diminutive orifice near the sternoclavicular joint, with the tract extending deeply into the subcutaneous tissue and terminating blindly, short of entering the joint, after a distance of 10 mm (ranging from 5 to 21 mm). Histopathological analysis revealed that the epithelial lining predominantly consisted of stratified squamous epithelium (87.8%), with ciliated columnar epithelium accounting for the remaining 12.2%.

CONCLUSIONS

CSCS, though infrequent, presents with distinctive pathological and clinical features. The condition predominantly affects the left sternoclavicular joint region, with the notable "skin streak sign" aiding in diagnosis. We considered CSCS as one disease entity of branchial arch anomalies. Complete surgical excision offers a definitive cure.

LEVEL OF EVIDENCE

4 Laryngoscope, 2024.

Congenital dermoid sinus of anterior chest: Case report and review of literature

INTRODUCTION

Congenital dermoid sinus which is a rare congenital anomaly of the anterior chest wall (CDACR) is frequently misdiagnosed or mistreated. This report aims to raise awareness about this condition and share experience based on a demarcation technique for anomalous tissue.

PRESENTATION OF CASE

A case of surgically treated CDACR in our clinic and subsequently confirmed through histopathology was chosen. Health records such as, demographics, visits, imaging modalities, management, outcome, and histopathology were reviewed of the patient.

DISCUSSION

Our patient aged 4 years underwent ultrasonography, which revealed a dermoid sinus on her right anterior chest. This diagnosis was later confirmed via histopathology after the excision of the sinus, which was facilitated by a mix of methylene blue and fibrin glue. The incision healed well without any complications.

CONCLUSION

Thus, it was found that CDACRs are those rare congenital anomalies requiring immediate excision to prevent recurrent infections or complications. Knowing how to identify and deal with them is essential.

Masses of the Sternoclavicular Area: Case Series and Review of the Literature

Objective:

Masses of the sternoclavicular area are rare, and are not well described in the literature. We aim to present a series of patients with masses in this location and to review all reported English language cases of sternoclavicular masses in pediatric patients.

Methods:

This is a case series of pediatric patients with masses of the sternoclavicular area presenting to a tertiary care pediatric hospital from 2010 through 2017. Data was collected by using ICD-9 and ICD-10 codes to query the electronic medical record. Chart review included age at presentation, mass characteristics, medical and surgical interventions, and pathology results. A review of the literature was then performed.

Results:

Ten patients with masses overlying the sternoclavicular area were identified. Four patients presented with abscess and were treated with incision and drainage. Three of these patients were then treated with staged excision once infection cleared. Two additional patients were treated with primary excision. Four patients were treated with observation. The most common histopathologic finding was epidermoid. One patient was found to have a dermoid cyst, and 1 had a congenital cartilaginous rest.

Conclusion:

Epidermoids and dermoids are the most common masses overlying the sternoclavicular area. Controversy remains regarding the embryologic origin of sternoclavicular masses. The differential for masses in this area also includes branchial remnants, bronchogenic cysts, ganglion cysts, or septic arthritis.

The congenital sternoclavicular sinus: a single-institution retrospective study of 88 patients

BACKGROUND

Sinus near the sternoclavicular joint was considered as a rare congenital neck abnormality. Though it was reported as a dermoid sinus in some literatures, the embryological origin of the sinus was unclear. This study aimed at reviewing the clinical and histological characteristics and analyzing the possible embryological origin of this malformation in children.

METHODS

The medical records of all patients with congenital sternoclavicular sinus who underwent surgical resection between March 2018 through June 2020 were reviewed retrospectively. The clinical presentations, complications, histological examination, and treatment were analyzed.

RESULTS

Of the 88 patients with congenital sternoclavicular sinus included, the mean age of surgery was 2.73 ± 1.71 years old. The sinuses occurred on the left side in 73 (83.0%) cases. Sixty-three patients experienced sinus infection and 44 patients underwent incision and drainage before excision. All patients received surgical resection with one patient who recurred after surgery. Histopathological examination showed that the sinuses were lined by squamous epithelium in most patients. However, ciliated epithelium was observed in one patient and salivary glands were detected in two patients.

CONCLUSIONS

The congenital sternoclavicular sinus should be excised promptly to prevent recurrent infection. According to the ciliated epithelium and salivary gland were found in the wall of sinus, it should be viewed as the skin side remnant of the fourth branchial cleft rather than a dermoid cyst/sinus.

Congenital dermoid sinus of the anterior chest region

BACKGROUND

Congenital dermoid sinus of the anterior chest region (CDACR) is a rare developmental anomaly. Therefore, the aim of our study was to draw attention to this underrecognized lesion.

METHODS

From 2011 to 2019, our study group included 11 patients who presented to our hospital with pits and masses of their anterior chest walls. All lesions were surgically excised with histologic confirmation of the diagnosis of CDACR. The medical records of these patients were reviewed for the following data: patient age, gender, clinical characteristics of the lesion and site of involvement, department first visited, diagnostic evaluation, management, postoperative complications, and histopathological findings.

RESULTS

There was a clear left-sided predominance, with 10/11 cases occurring on the left and a female predominance of eight cases out of 11. Although the pits were present at birth, the mean age at presentation was 19.7 months. All patients showed clinical signs of infection at the time of presentation and were treated with antibiotics. Seven patients had a history of abscess formation treated with incision and drainage. Ultrasound was performed in eight patients. In all cases, the lesions, including pit and sinus, were completely excised.

CONCLUSIONS

Congenital dermoid sinus of the anterior chest region is likely underrecognized. We encountered a high frequency of complications such as infections or abscesses prior to surgical excision. Complete excision of CDACR is not technically difficult. Therefore, surgical removal should be considered, even for asymptomatic lesions, to avoid future complications and for cosmesis.

Cutaneous ultrasound and its utility in Pediatric Dermatology: Part II-Developmental anomalies and vascular lesions

High-frequency ultrasonography represents a promising tool for pediatric dermatologists. It is a noninvasive and harmless diagnostic technique that is especially appealing when working with children. It can be easily performed at the patient's bedside, avoiding diagnostic delays, sedation, or multiple visits. It represents a useful adjunct to clinical examination and aids our understanding of cutaneous pathology. In this second part, we describe the ultrasonographic findings of developmental anomalies and vascular lesions.

Ultrasound Evaluation of Dermal Sinuses/Fistulas in Pediatric Patients

A dermal sinus/fistula is a common condition; the relevant department should be consulted for appropriate treatment. It is important for radiologists to have adequate knowledge of these conditions to provide the correct diagnosis and recommend subsequent management. This review describes the following lesions: preauricular sinus, midline sinus of the upper lip, nasal dermoid sinus cyst, cheek fistula, first branchial cleft anomaly/sublingual branchial cleft anomaly, thyroglossal duct cyst/fistula, lateral cervical sinus/fistula, congenital dermal sinus/fistula of the anterior chest region, congenital skin sinus/fistula with a sternal cleft, and congenital prepubic sinus. On the basis of the skin orifice location and ultrasound images, radiologists can provide useful information to physicians.

Sternoclavicular sinus: Case series and literature review of a rare head and neck lesion

OBJECTIVE

The objective of this study is to describe the clinical and pathologic features of a rare congenital neck anomaly, a sternoclavicular sinus, and review the literature on this topic.

STUDY DESIGN

This study is a retrospective case series of four subjects diagnosed with a sternoclavicular sinus.

METHODS

Patients with a congenital neck anomaly, distinct from common branchial cleft anomalies, were identified through a 10-year retrospective chart review of a tertiary care pediatric otolaryngology practice.

RESULTS

We describe four patients with a congenital neck anomaly with common features of a sternoclavicular anomaly. All patients presented with a superficial neck anomaly adjacent to the sternoclavicular joint. Surgical excision through an external approach was successfully performed in three out of the four patients with subsequent resolution of symptoms. The literature review compiles all the cases presented. Theories on embryologic origin include incomplete fusion of sternum and clavicle or unusual remnant of a fourth branchial cleft. Commonalities include left sided predominance, squamous epithelium lined sinus tract ending at the sternoclavicular junction, and successful surgical excision in almost all cases.

CONCLUSION

A sternoclavicular sinus is a rarely described congenital neck abnormality. Presentation and management is similar to branchial cleft anomaly but with a distinct anatomical pathway that is important for surgeons to recognize.

LEVEL OF EVIDENCE

This manuscript presents a case series. The level of evidence proposed is Level 4.

Congenital dermoid fistulas of the anterior chest region (CDFACR): usefulness of sonography for complete resection

Congenital dermoid fistulas of the anterior chest regions (CDFACRs) consist of a skin orifice at the anterior border of the sternocleidomastoid muscle with fistulas extending caudally in the subcutaneous tissue near the sternoclavicular joint. We report 2 pediatric CDFACR cases with pathognomonic sonography findings. By using sonography, we could diagnose the fistulas as CDFACRs by focusing on their location and direction and could reveal the distal side for complete resection. We suggest that sonography, which does not involve radiation or require sedation, is a better choice for the initial examination of CDFACRs than computed tomography or MRI.