BRANCHIAL ANOMALIES AND NEOPLASMS: A REPORT OF THIRTY-TWO CASES WITH FOLLOW-UP RESULTS

Blunt Force May be an Effective Treatment for Ganglion Cysts

BACKGROUND

Ganglion cysts are the most common soft tissue tumors of the hand and wrist. There is currently no data available for the recurrence or complication rate of patients that self treat ganglion cysts by using an extrinsic force. Despite this absence of evidence, patients are still using this mode of treatment.

QUESTIONS/PURPOSES

The purpose of the study is to evaluate the efficacy of blunt force as a treatment modality for disrupting ganglion cysts.

METHODS

We analyzed videos of patients attempting to disrupt their ganglion cysts of the wrist by blunt force on Youtube.com and surveyed them anonymously. Candidates were contacted through YouTube's email server and given a link to an online questionnaire.

RESULTS

Two hundred fourteen individuals were reviewed with a total of 1,008,913 views. Eighty three percent of videos were effective in treating the cyst. All 38 individuals that responded to the survey reported that the blunt force was effective in immediate elimination of the cyst in an average of 1.6 attempts (range 1-5). A majority (N = 21, 55%) reported no recurrence since the initial disruption of the cyst at a follow-up of 24 months.

CONCLUSIONS

YouTube.com was found to be an effective outlet to study a treatment modality that would otherwise be limited by practical considerations. The study showed that a subset of patients is utilizing blunt force trauma to successfully treat wrist ganglion cysts.

Innovation and surgical techniques: endoscopic resection of cervical branchiogenic cysts

The recent advent of endoscopic procedures has compelled both plastic and neck and head surgeons to reconsider the conventional methods by which the excision of cervical congenital cystic is classically achieved.An endoscopic approach for excision of the cervical congenital cystic is described. This procedure is anatomically safe and can be made with minimal morbidity through a small transcervical incision. Both specific instruments and solid anatomical knowledge are necessary to perform a safe and efficient cystic endoscopic excision. The essential surgical steps are as follows: 1. Minimal incision placed in natural cervical wrinkle over the dome of the cyst; 2. Intracystic or extracystic dissection; 3. Identification and protection of the sternocleidomastoid muscle, spinal nerve, hypoglossi nerve, and posterior belly of digastric muscle; 4. Careful dissection of the posterior surface of the cyst, avoiding injury on the carotid vessels and internal jugular vein. Eight patients were operated on with this technique and they were very pleased with postoperative comfort and aesthetic results. Inconspicuous scars and no complications were registered. With advanced endoscopic instruments and the development of new surgical technique and surgeon experience, the endoscopic surgery can be the method of choice in cervical excision of branchiogenic cysts.

Primary branchiogenic carcinoma

An extensive historical review of branchial cleft cyst carcinoma is undertaken and a critical analysis of all 67 cases reported in the English literature since Martin's landmark report is carried out and tabulated. Forty-one of the 67 cases were definitely ruled out as carcinomas of branchial cysts. Though only eight of the remaining 26 cases satisfied Martin's criterion of 5-year follow-up without evidence of primary carcinoma elsewhere, 14 patients had incontrovertible evidence of branchiogenic carcinoma, evidenced by a branchial cyst with histologic evidence of epithelial dysplasia progressing to squamous cell carcinoma within the cyst wall. Two previously unreported cases are presented. A therapeutic approach including wide local excision, radical neck dissection, and radiotherapy is recommended. A more thorough search for an occult head and neck primary, and a clearer understanding of the histopathology of branchiogenic carcinoma, are suggested as alternate requirements for this diagnosis.

Lateral cervical anomaliew and salivary heterotopia

It is widely accepted that most lateral cervical fistulas with an external opening in the suprasternal region orginate from second branchial arch remnants. Lateral cervical cysts occur higher in the neck and according to current theories, may develop either from the branchial apparatus or from glandular inclusions in cervical lymph nodes. An histological study revealed salivary tissue in 9 of 24 fistulas, 5 of these representing a congenital cervical salivary sinus, while only one of 17 cysts showed salivary heterotopia. This investigation indicates that salivary tissue may occur more commonly in the lateral neck than is generally realised, and that lateral cervical cystis and fistulas probably differ in their histogenesis.

Branchiogenic carcinoma

An unusual case of upper cervical carcinoma probably of true branchial origin is presented and the literature relevant to this condition reviewed. Branchiogenic carcinoma is a rare condition and should not be diagnosed in the absence of the 4 criteria laid down by Dr Hayes Martin, viz. that the carcinoma should arise in the wall of a branchial cyst, that it should occur along a line from the tragus to the clavicle along the anterior border of sternomastoid, that the histology should be compatible with the branchial apparatus and that no other primary tumour should come to light in a 5-year follow-up. A fifth criterion, ie. the demonstration of premalignant changes in the epithelium of the cyst, is suggested to aid a conclusive diagnosis.