1
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Roh JL. Scarless Excision of Second Branchial Cleft Cyst via Retroauricular Hairline Incision. Aesthetic Plast Surg 2024; 48:1264-1270. [PMID: 38097689 DOI: 10.1007/s00266-023-03770-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/17/2023] [Indexed: 04/24/2024]
Abstract
BACKGROUND Second branchial cleft cyst (2nd BCC) is treated by complete excision. Conventional transcervical skin incision on the lesion may leave a prominent scar in the cosmetically sensitive area. The retroauricular hairline incision (RAHI) approach may maintain neurological, mobility, and cosmetic functions of the neck and face after excision. This study evaluated the clinical outcomes and disease control of scarless surgery via RAHI in 57 consecutive patients with 2nd BCC. METHODS The patients received the prospective evaluation of postoperative neurological, subjective pain, swallowing, neck motion, and cosmetic functions. Postoperative complications, subjective satisfaction, and recurrence were also assessed in each patient. RESULTS Excision was performed in all cases without injury to the facial nerve or other neurological complications and conversion to other incisions or approaches with a median operation time of 44 min. Complications were minimal, without dysphagia, neurological deficits, or limited neck motion. Postoperative incision scars in the postauricular and hairline region were commonly invisible. Subjective satisfaction with the scar and facial deformity was high after surgery. No patients had a recurrence for a median follow-up of 66 months. CONCLUSION The RAHI approach for 2nd BCC has excellent cosmetic, functional, and disease control outcomes. This can be safely applied to the treatment of 2nd BCC. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Gyeonggi-do, 13496, Republic of Korea.
- Department of Biomedical Science, General Graduate School, CHA University, Seongnam, Republic of Korea.
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2
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Singh C, Silky S, Agarwal AC, Gupta T, Sinha M, Sharma P. Perplexing First Branchialcleft Anomalies-A Case Series with Review of Literature. Indian J Otolaryngol Head Neck Surg 2024; 76:1454-1460. [PMID: 38440503 PMCID: PMC10909038 DOI: 10.1007/s12070-023-04243-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/20/2023] [Indexed: 03/06/2024] Open
Abstract
Incomplete obliteration of the branchial apparatus results in the formation of branchial cleft anomalies. First branchial cleft anomalies may persist anywhere in the first branchial arch, from the external auditory canal at the level of the bony cartilaginous junction to the submandibular triangle. The majority of cases present in childhood as an opening in the skin though they may present as cysts or neck masses, mostly mistaken for neck abscesses which leads to inadequate treatment and complications. Here different cases of first branchial cleft anomalies with variable presentation and treatment are illustrated. The need for proper diagnosis and adequate treatment cannot be overemphasized to avoid mismanagement and complications.
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Affiliation(s)
- Charu Singh
- Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh India
| | - Silky Silky
- Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh India
| | | | - Tejaswi Gupta
- Mayo Institute of Medical Sciences, Lucknow, Uttar Pradesh India
| | - Mohit Sinha
- Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh India
| | - Pooja Sharma
- Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh India
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3
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Wilson J, Jaju A, Wadhwani N, Gorelik M, Johnston D, Rastatter J, Bhushan B, Hazkani I, Fudyma I, Maddalozzo J. Reworking Classification of First Branchial Cleft Anomalies. Laryngoscope 2024; 134:459-465. [PMID: 37272866 DOI: 10.1002/lary.30783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/22/2023] [Accepted: 05/13/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To evaluate the clinical features of first branchial cleft anomalies (BCAs) and their relationship to pre-operative imaging, pathologic data, and post-operative surveillance outcomes. Additional aims were to assess the validity of the Work classification and describe features of recurrent cysts. METHODS Records for 56 children (34 females, 22 males; age at surgery of 5.6 ± 4.4 years) collected over a 12-year period (2009-2021) were reviewed. Imaging and pathologic slides were re-reviewed in a blinded fashion by experts in those respective areas. Parents were contacted via telephone to obtain extended follow-up. An alternate classification method based on the presence (type II) or absence (type I) of parotid involvement is provided. RESULTS Only 55% of first BCAs could be successfully classified using Work's method. First BCAs within the parotid were more likely to present with recurrent infections, involve scarred tissue planes and lymphadenopathy, and demonstrate enlarged lymphoid follicles on pathology. The overall recurrence rate was 16%, and recurrence was 5.3 times more likely when external auditory canal cartilage was not resected. Preoperative imaging was useful for predicting the extent of surgery required and the presence of scarred tissue planes. CONCLUSION First BCAs within the parotid gland involve more difficult and extensive surgical resection and the potential for morbidity related to facial nerve dissection. Appropriately aggressive surgical resection, which may include the resection of involved ear cartilage, is necessary to prevent morbidity related to recurrence. LEVEL OF EVIDENCE 4 Laryngoscope, 134:459-465, 2024.
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Affiliation(s)
- John Wilson
- Division of Otorhinolaryngology - Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Alok Jaju
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nitin Wadhwani
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Michael Gorelik
- Division of Otorhinolaryngology - Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Douglas Johnston
- Division of Otorhinolaryngology - Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jeffrey Rastatter
- Division of Otorhinolaryngology - Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Bharat Bhushan
- Division of Otorhinolaryngology - Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Inbal Hazkani
- Division of Otorhinolaryngology - Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Iga Fudyma
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - John Maddalozzo
- Division of Otorhinolaryngology - Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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4
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da Silva EMS, Tonello G, Gris AH, Almeida BA, Rosa RB, Frigeri KDM, Panziera W, Driemeier D. Anatomopathological characterization of branchial cysts in slaughtered pigs. J Comp Pathol 2023; 207:10-13. [PMID: 37871534 DOI: 10.1016/j.jcpa.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/07/2023] [Accepted: 09/23/2023] [Indexed: 10/25/2023]
Abstract
Branchial cysts are a congenital anomaly in humans and other animal species. In this study, twenty commercially bred slaughtered pigs ranging from 120 to 150 days of age, sourced from different farms and lots, were found to have cysts in the oropharyngeal region at meat inspection despite the absence of clinical signs. Two cysts were selected for histopathological examination. The first cyst was surrounded by fibrous connective tissue and lined by a simple single cell layer of epithelium. The second cyst comprised a squamous pseudostratified to simple stratified epithelium, accompanied by a mild inflammatory infiltrate. This cyst was also surrounded by fibrous connective tissue and glands. The pathological diagnosis of branchial cysts in slaughtered pigs was established on the basis of their anatomical location and gross and microscopic findings.
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Affiliation(s)
- Emanoelly M S da Silva
- Setor de Patologia Veterinária, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9090, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Graciela Tonello
- Bestsui Alimentos, Estrada Engenho Velho Constantina, Linha Trombetta, Engenho Velho, Rio Grande do Sul, Brazil
| | - Anderson H Gris
- Setor de Patologia Veterinária, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9090, Porto Alegre, Rio Grande do Sul, Brazil
| | - Bruno A Almeida
- Setor de Patologia Veterinária, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9090, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rafael B Rosa
- Setor de Patologia Veterinária, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9090, Porto Alegre, Rio Grande do Sul, Brazil
| | - Karen D M Frigeri
- Universidade Tecnológica Federal do Paraná, Estrada Boa Esperança, Dois Irmãos, Paraná, Engenho Velho, Rio Grande do Sul, Brazil
| | - Welden Panziera
- Setor de Patologia Veterinária, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9090, Porto Alegre, Rio Grande do Sul, Brazil
| | - David Driemeier
- Setor de Patologia Veterinária, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9090, Porto Alegre, Rio Grande do Sul, Brazil
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5
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Abstract
Congenital cystic masses are commonly encountered when imaging a patient presenting with a neck mass. Congenital cysts are present at birth; however, these cysts may not present until later in life with some growing slowly and others rapidly increasing in size due to hemorrhage of infection. A neonatal presentation is rare but when present may allow a narrower differential diagnosis. Imaging plays a significant role in defining a lesion as cystic, assessing location, and directing the next step in evaluation and or intervention.
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Affiliation(s)
- Timothy N Booth
- University of Texas Southwestern, Children's Health of Texas, 1935 Medical District Drive, Dallas, TX 75235, USA.
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6
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Suzuki Y, Toriumi M, Takano J. Idiopathic Palatal Fistula of the Left Soft Palate. J Craniofac Surg 2023; 34:e686-e688. [PMID: 37552136 DOI: 10.1097/scs.0000000000009596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 06/25/2023] [Indexed: 08/09/2023] Open
Abstract
Palatal fistulas, often congenital or trauma-induced, are occasionally encountered in the field of plastic surgery. We report a case of a non-medial 3 mm soft palate fistula in a 43-year-old woman, with no apparent trigger or history of local trauma or infection. The fistula, extending 2 cm toward the lateral pharyngeal wall, was surgically removed under general anesthesia as it was impacting the patient's quality of life. The lumen was stained, and the fistula was removed in one mass. The excised tissue was covered with stratified squamous epithelium and was surrounded by adherent tonsil tissue. No recurrence was observed postoperatively. Despite an initial suspicion of a congenital cause, the fistula's lateral extension and histology suggested a possible origin from the second pharyngeal pouch. To date, there are no reports of fistulas opening on the soft palate. Therefore, this presents an exceptionally rare instance of a soft palate fistula.
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Affiliation(s)
- Yushi Suzuki
- Department of Plastic and Reconstructive Surgery, JCHO Saitama Medical Center, Saitama
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Toriumi
- Department of Plastic and Reconstructive Surgery, JCHO Saitama Medical Center, Saitama
| | - Junji Takano
- Department of Plastic and Reconstructive Surgery, JCHO Saitama Medical Center, Saitama
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7
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Toro-Tobon S, Manrique M, Paredes-Gutierrez J, Mantilla-Rivas E, Oh H, Ahmad L, Oh AK, Rogers GF. Pharyngeal Arches, Chapter 1: Normal Development and Derivatives. J Craniofac Surg 2023; 34:2237-2241. [PMID: 37264513 PMCID: PMC10521768 DOI: 10.1097/scs.0000000000009374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/10/2023] [Indexed: 06/03/2023] Open
Abstract
The pharyngeal arches form the cornerstone of the complex anatomy of the face and neck. These embryologic structures are the foundation of face and neck development, and anomalous growth can result in craniofacial abnormalities. Surgeons who manage head and neck pathology and pathoanatomy will invariably encounter conditions associated with aberrant pharyngeal arch anatomy, and a thorough understanding of the normal and pathological development of these important structures is paramount to accurate diagnosis and treatment. This manuscript is the first of a three-part educational series that addressed the pharyngeal/branchial arch embryology, development, nomenclature, and normal anatomy (Part I), pathologic anomalies of ear and neck derived from abnormal development of the arches (Part II), and different types of orofacial clefts, including Tessier clefts (Part III).
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8
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Chauhan I, Thakur S. Complete Second Branchial Fistula: A Rare Entity. Indian J Otolaryngol Head Neck Surg 2023; 75:2277-2280. [PMID: 37636742 PMCID: PMC10447773 DOI: 10.1007/s12070-023-03570-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/06/2023] [Indexed: 02/19/2023] Open
Abstract
Second branchial anomalies like branchial cyst, sinus or fistula are common lateral neck masses in pediatric age group but it is rare to encounter complete branchial fistula with external as well as internal openings. We present a case of 16 yrs old female patient with complete Branchial fistula which was diagnosed with the help of CT fistulogram and thereafter taken up for surgical excision of fistula under general anaesthesia. Histopathology confirmed the diagnosis of branchial fistula. In case of lateral neck mass with external opening in pediatric age group strong possibility of diagnosis of branchial fistula should be kept, timely management of the case improves the quality of life.
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9
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Tarazis K, Garefis K, Garefi M, Nikolaidis V, Chatziavramidis A, Markou K. First Branchial Cleft Anomalies: Rare Work Type I and Type II Entities. Ear Nose Throat J 2023; 102:NP383-NP385. [PMID: 33993773 DOI: 10.1177/01455613211015737] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
First branchial cleft anomalies (FBCAs) are the most infrequent malformations that occur during the development of the branchial apparatus, appearing in less than 8% of all branchial anomalies. Traditionally, they are classified into Work type I and II, depending on their origin. We present a pair of rare FBCAs: a case of a preauricular Work type I cyst with twin fistulae coursing toward the parotid gland and a Work type II cyst of significant dimensions.
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Affiliation(s)
- Konstantinos Tarazis
- 2nd Academic ORL, Head and Neck Surgery Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Konstantinos Garefis
- 2nd Academic ORL, Head and Neck Surgery Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Maria Garefi
- Department of Pediatric, General Hospital of Veroia, Veroia, Greece
| | - Vasilios Nikolaidis
- 2nd Academic ORL, Head and Neck Surgery Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Angelos Chatziavramidis
- 2nd Academic ORL, Head and Neck Surgery Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Konstantinos Markou
- 2nd Academic ORL, Head and Neck Surgery Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
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10
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Caseiro Alves ME, Nunes A, Galhardo J. Case report: Fourth branchial cleft cyst: a case of acute suppurative thyroiditis. Front Pediatr 2023; 11:1212767. [PMID: 37484775 PMCID: PMC10361755 DOI: 10.3389/fped.2023.1212767] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/23/2023] [Indexed: 07/25/2023] Open
Abstract
This case report presents a 4 year-old-female patient with a neck mass who was diagnosed with an infected fourth branchial cleft cyst with left thyroid lobe involvement through fistulation. The case emphasizes the importance of considering uncommon etiologies, such as congenital anomalies, as a differential diagnosis when evaluating pediatric neck masses. The patient was prescribed broad-spectrum antibiotics, which led to the regression of the mass and inflammatory signs. Close follow-up in endocrinology and otorhinolaryngology appointments was maintained, and after 7 months, hypoplasia of the left lobe was observed. Thyroid function was reevaluated, and after two years, no recurrences were noted. The case highlights the significance of a comprehensive examination and assessment of corresponding clinical features, which can significantly reduce the rate of misdiagnoses and achieve an individualized diagnosis.
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Affiliation(s)
- M. Eduarda Caseiro Alves
- Pediatric Department, Hospital Dona Estefânia, Centro Hospitalar e Universitário de Lisboa Central, Lisbon, Portugal
| | - Ana Nunes
- Radiology Department, Hospital Dona Estefânia, Centro Hospitalar e Universitário de Lisboa Central, Lisbon, Portugal
| | - Júlia Galhardo
- Unit of Pediatric Endocrinology, Centro Hospitalar e Universitário de Lisboa Central, Lisbon, Portugal
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11
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D'Arco F, Lee P, Siddiqui A, Nash R, Ugga L. Radiologic diagnosis of non-traumatic paediatric head and neck emergencies. Pediatr Radiol 2023; 53:768-782. [PMID: 36481939 DOI: 10.1007/s00247-022-05556-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/18/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Abstract
Imaging plays a crucial role in evaluating paediatric patients with non-traumatic head and neck lesions in an emergency setting because clinical manifestations of these entities can overlap. For this reason, radiologists must be familiar with the clinical and imaging findings of prevalent paediatric head and neck emergencies. In this review, we present techniques and imaging clues for common complications of pathological processes in the paediatric head and neck, with a focus on the clinical scenario as a starting point for the radiologic approach.
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Affiliation(s)
- Felice D'Arco
- Department of Radiology, Neuroradiology Unit, Great Ormond Street Hospital, London, UK
| | - Philippa Lee
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Ata Siddiqui
- Radiology Department, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Robert Nash
- Ear, Nose and Throat Department, Great Ormond Street Hospital, London, UK
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Sergio Pansini 5, 80131, Naples, Italy.
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12
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Ma AC, Bacon BR, Danziger I, Carr MM. First Branchial Cleft Cyst Confined to the Pinna. Cureus 2023; 15:e36829. [PMID: 37123784 PMCID: PMC10147492 DOI: 10.7759/cureus.36829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
First branchial cleft cysts (FBCCs) arise due to an incomplete fusion of the cleft between the first and second branchial arches. Classically, they are found inferior to the pinna or along the external auditory canal. This report presents a unique case of a nine-month-old male with a first branchial cleft cyst completely within the pinna. The patient presented with a left auricular pit and pinna mass. Ultrasound revealed a homogeneous hypoechoic mass isolated to the pinna. Surgical resection revealed the cyst to be anterior to the inferior pinna cartilage, with the tract projecting anteriorly and inferiorly. Final pathology revealed a benign cyst lined by squamous epithelium and a rim of cartilage, confirming an FBCC. To our knowledge, FBCCs isolated to the pinna have not been previously reported. Awareness of the various presentations of this rare anomaly is essential for a prompt and accurate diagnosis.
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13
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Jung CK, Agarwal S, Hang JF, Lim DJ, Bychkov A, Mete O. Update on C-Cell Neuroendocrine Neoplasm: Prognostic and Predictive Histopathologic and Molecular Features of Medullary Thyroid Carcinoma. Endocr Pathol 2023; 34:1-22. [PMID: 36890425 DOI: 10.1007/s12022-023-09753-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 03/10/2023]
Abstract
Medullary thyroid carcinoma (MTC) is a C-cell-derived epithelial neuroendocrine neoplasm. With the exception of rare examples, most are well-differentiated epithelial neuroendocrine neoplasms (also known as neuroendocrine tumors in the taxonomy of the International Agency for Research on Cancer [IARC] of the World Health Organization [WHO]). This review provides an overview and recent evidence-based data on the molecular genetics, disease risk stratification based on clinicopathologic variables including molecular profiling and histopathologic variables, and targeted molecular therapies in patients with advanced MTC. While MTC is not the only neuroendocrine neoplasm in the thyroid gland, other neuroendocrine neoplasms in the thyroid include intrathyroidal thymic neuroendocrine neoplasms, intrathyroidal parathyroid neoplasms, and primary thyroid paragangliomas as well as metastatic neuroendocrine neoplasms. Therefore, the first responsibility of a pathologist is to distinguish MTC from other mimics using appropriate biomarkers. The second responsibility includes meticulous assessment of the status of angioinvasion (defined as tumor cells invading through a vessel wall and forming tumor-fibrin complexes, or intravascular tumor cells admixed with fibrin/thrombus), tumor necrosis, proliferative rate (mitotic count and Ki67 labeling index), and tumor grade (low- or high-grade) along with the tumor stage and the resection margins. Given the morphologic and proliferative heterogeneity in these neoplasms, an exhaustive sampling is strongly recommended. Routine molecular testing for pathogenic germline RET variants is typically performed in all patients with a diagnosis of MTC; however, multifocal C-cell hyperplasia in association with at least a single focus of MTC and/or multifocal C-cell neoplasia are morphological harbingers of germline RET alterations. It is of interest to assess the status of pathogenic molecular alterations involving genes other than RET like the MET variants in MTC families with no pathogenic germline RET variants. Furthermore, the status of somatic RET alterations should be determined in all advanced/progressive or metastatic diseases, especially when selective RET inhibitor therapy (e.g., selpercatinib or pralsetinib) is considered. While the role of routine SSTR2/5 immunohistochemistry remains to be further clarified, evidence suggests that patients with somatostatin receptor (SSTR)-avid metastatic disease may also benefit from the option of 177Lu-DOTATATE peptide radionuclide receptor therapy. Finally, the authors of this review make a call to support the nomenclature change of MTC to C-cell neuroendocrine neoplasm to align this entity with the IARC/WHO taxonomy since MTCs represent epithelial neuroendocrine neoplasms of endoderm-derived C-cells.
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Affiliation(s)
- Chan Kwon Jung
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
| | - Shipra Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Jen-Fan Hang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Dong-Jun Lim
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, 296-8602, Japan
| | - Ozgur Mete
- Department of Pathology, University Health Network, Toronto, ON, M5G 2C4, Canada
- Endocrine Oncology Site, Princess Margaret Cancer, Toronto, ON, M5G 2C4, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, M5G 2C4, Canada
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14
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Chandola S, Jana M. Second Branchial Cleft Fistula. AJR Am J Roentgenol 2023; 220:443. [PMID: 36000668 DOI: 10.2214/AJR.22.28266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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15
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Dhawan SS, Yedavalli V, Massoud TF. Atavistic and vestigial anatomical structures in the head, neck, and spine: an overview. Anat Sci Int 2023:10.1007/s12565-022-00701-7. [PMID: 36680662 DOI: 10.1007/s12565-022-00701-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 12/27/2022] [Indexed: 01/22/2023]
Abstract
Organisms may retain nonfunctional anatomical features as a consequence of evolutionary natural selection. Resultant atavistic and vestigial anatomical structures have long been a source of perplexity. Atavism is when an ancestral trait reappears after loss through an evolutionary change in previous generations, whereas vestigial structures are remnants that are largely or entirely functionless relative to their original roles. While physicians are cognizant of their existence, atavistic and vestigial structures are rarely emphasized in anatomical curricula and can, therefore, be puzzling when discovered incidentally. In addition, the literature is replete with examples of the terms atavistic and vestigial being used interchangeably without careful distinction between them. We provide an overview of important atavistic and vestigial structures in the head, neck, and spine that can serve as a reference for anatomists and clinical neuroscientists. We review the literature on atavistic and vestigial anatomical structures of the head, neck, and spine that may be encountered in clinical practice. We define atavistic and vestigial structures and employ these definitions consistently when classifying anatomical structures. Pertinent anatomical structures are numerous and include human tails, plica semilunaris, the vomeronasal organ, levator claviculae, and external ear muscles, to name a few. Atavistic and vestigial structures are found throughout the head, neck, and spine. Some, such as human tails and branchial cysts may be clinically symptomatic. Literature reports indicate that their prevalence varies across populations. Knowledge of atavistic and vestigial anatomical structures can inform diagnoses, prevent misrecognition of variation for pathology, and guide clinical interventions.
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Affiliation(s)
- Siddhant Suri Dhawan
- Department of Bioengineering, Schools of Engineering and Medicine, Stanford University, Stanford, USA
| | - Vivek Yedavalli
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Tarik F Massoud
- Division of Neuroimaging and Neurointervention, and Stanford Initiative for Multimodality Neuro-Imaging in Translational Anatomy Research (SIMITAR), Department of Radiology, Stanford University School of Medicine, Stanford, USA. .,Center for Academic Medicine, Radiology MC: 5659; 453 Quarry Road, Palo Alto, CA, 94304, USA.
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Chen W, Zhou Y, Xu M, Xu R, Wang Q, Xu H, Chen J, Li X. Congenital second branchial cleft anomalies in children: A report of 52 surgical cases, with emphasis on characteristic CT findings. Front Pediatr 2023; 11:1088234. [PMID: 36937970 PMCID: PMC10020344 DOI: 10.3389/fped.2023.1088234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/14/2023] [Indexed: 03/06/2023] Open
Abstract
Objective The objectives of this study was to review the clinical features and surgical treatment outcomes of congenital second branchial cleft anomalies (CSBCAs) and to investigate the characteristic computed tomography (CT) findings of CSBCAs. Methods We conducted a retrospective study of 52 children who were referred to Shanghai Children's Hospital from October 2014 to December 2021 diagnosed as CSBCAs. Results There were 36 males and 16 females. Of them, 35 patients were presented as having a skin pit at birth or discharge from the skin opening on the lateral neck, and 17 patients presented with an asymptomatic or painful mass. The typical CT features of CSBCAs included isolated and homogeneously hypodense cystic lesions surrounded by a uniformly thin, smooth wall. CSBCAs were generally located at the anteromedial border of the sternocleidomastoid muscle, posterior to the submandibular gland, and lateral to the carotid sheath. All patients were treated surgically and only one case underwent ipsilateral tonsillectomy. After a median follow-up of 30 (range 4-90) months, no recurrence or complications were observed. Conclusions The CSBCAs show some characteristic CT findings, which can help clinicians diagnose and plan surgical strategies. High ligation of the lesions is sufficient for complete excision of CSBCAs.
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Affiliation(s)
- Wei Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yilong Zhou
- Department of Pediatric Otorhinolaryngology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Mengrou Xu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Rong Xu
- Department of Radiology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qingyu Wang
- Department of Pathology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hongming Xu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiarui Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyan Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Correspondence: Xiaoyan Li
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Schwan FE, Künzel J, Weber F, Vielsmeier V, Bohr C, Andorfer KEC. Lateral neck cyst surgery without ipsilateral tonsillectomy: a retrospective analysis. Eur Arch Otorhinolaryngol 2023; 280:315-20. [PMID: 35852652 DOI: 10.1007/s00405-022-07542-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/04/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE Several theories have been proposed regarding the origin of lateral neck cysts (LNC). Besides complete surgical resection ipsilateral tonsillectomy and dissection of a tract or its remnants is sometimes recommended. In this retrospective trial we wanted to evaluate if patients, who received LNC resection only, develop complications or recurrence to justify this surgical strategy. METHODS Patients who received LNC resection between 2004 and 2017 at the Ear Nose and Throat Department of a university hospital were included. Data was collected from the clinic database and through a structured telephone interview. RESULTS A total of 126 patients met the inclusion criteria. In this collective, the diagnosis of a lateral neck cyst was confirmed histologically. Mean age at time of operation was 38 years (± 14.6). The median follow-up time was 7 years (range 3-18). None of the participants experienced recurrent unilateral pharyngitis or tonsillitis during follow-up. Furthermore, there was no case of postoperative peritonsillar, neck phlegmon or neck abscess. No patient reported recurrence of LNC. CONCLUSIONS Sole complete resection of LNCs is sufficient to avoid postoperative infections and recurrences. Therefore, ipsilateral tonsillectomy and tract dissection is not necessary in routine cases of LNC surgery.
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Mccullagh KL, Shah RN, Huang BY. Anatomy of the Larynx and Cervical Trachea. Neuroimaging Clin N Am 2022; 32:809-829. [DOI: 10.1016/j.nic.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Lim RCA, Loh TL, Yahaya Z, Wan Hamizan AK. Fourth Branchial Pouch Sinus: A Rare, Often Misdiagnosed Congenital Anomaly. Indian J Otolaryngol Head Neck Surg 2022; 74:1964-1966. [PMID: 36452519 PMCID: PMC9702030 DOI: 10.1007/s12070-020-01941-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/27/2020] [Indexed: 11/27/2022] Open
Abstract
Pathologies of the branchial apparatus originate from abnormal embryological development and frequently affects the second branchial cleft. Fourth branchial cleft lesions are exceptionally few and existing literature on it is scarce. We present a case of a fourth branchial pouch sinus, masquerading as a recurrent neck abscess.
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Affiliation(s)
- Rachel C. A. Lim
- Department of Otorhinolaryngology and Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latiff, 56000 Cheras, Kuala Lumpur Malaysia
| | - Tze Liang Loh
- Department of Otorhinolaryngology, Hospital Sultan Ismail, Jalan Mutiara Emas Utama, Taman Mount Austin, 81100 Johor Bahru, Johor Malaysia
| | - Zakinah Yahaya
- Department of Otorhinolaryngology, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur, Malaysia
| | - Aneeza Khairiyah Wan Hamizan
- Department of Otorhinolaryngology and Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latiff, 56000 Cheras, Kuala Lumpur Malaysia
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Sigdel B, Neupane B, Ranabhat S, Pokhrel A, Jha AK. Microscopic assisted excision of a rare posterior triangle branchial cyst. Clin Case Rep 2022; 10:e6034. [PMID: 35846924 PMCID: PMC9272215 DOI: 10.1002/ccr3.6034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/23/2022] [Indexed: 11/08/2022] Open
Abstract
Branchial cyst is a painless mass commonly located in the anterior triangle of the neck. It is rarely found in the posterior triangle of the neck. A computed tomography scan of the neck is important to see the extent of the anomaly and its relationship with the major vessel.
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Affiliation(s)
- Brihaspati Sigdel
- Department of Otolaryngology & Head and Neck Surgery Gandaki Medical College Kathmandu Nepal
- Metrocity Hospital Pokhara Nepal
| | - Bhima Neupane
- Department of Anatomy Manipal College of Medical Sciences Pokhara Nepal
| | - Sunita Ranabhat
- Department of Pathology Gandaki Medical College Kathmandu Nepal
| | | | - Ameet K. Jha
- Department of Anatomy, College of Medicine Texila American University Sparendaam Guyana
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周 宜, 陈 伟, 徐 蓉, 陈 佳, 李 晓. [Study on CT features of congenital branchial cleft anomaly in children]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2022; 36:441-447. [PMID: 35822362 PMCID: PMC10128494 DOI: 10.13201/j.issn.2096-7993.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Indexed: 04/30/2023]
Abstract
Objective:To summarize the CT features of congenital branchial cleft anomaly in children, to reduce misdiagnosis and improve surgical strategy. Methods:This study enrolled 323 pediatric patients with congenital first branchial cleft anomaly, congenital second branchial cleft anomaly and congenital piriform sinus fistula confirmed by surgery and post-operative histopathology, who was admitted to Shanghai Children's hospital from August 2014 to January 2021., CT imaging data were retrospectively analyzed. Results:A total of 323 children with congenital branchial cleft deformity were included. There were 145 males and 178 females, aged from 22 days to 15 years. 119(119/323, 36.8%) cases were diagnosed as congenital first branchial cleft anomaly. Among them, 96 cases(96/119, 80.67%) were related to the wall of external auditory canal, and 89 cases(89/119, 74.78%) were related to parotid gland. The positive rate of CT examination was 87.4%(104/119). 57 cases(57 / 323, 17.6%) had congenital second branchial cleft anomaly. Among them, 46 cases(46/57, 80.7%) were related to submandibular gland. The positive rate of CT examination was 84.2%(48/57). 147 cases(147/323, 45.5%) had congenital piriform sinus fistula, in which 129 cases(129/147, 87.8%) were related to thyroid. The positive rate of CT was 89.1%(131/147). Conclusion:The CT findings of congenital first branchial cleft anomaly are characterized by lesions in the inferior and/or posterior wall of ipsilateral external auditory canal and parotid gland. The CT features of congenital second branchial cleft anomaly are that the lesion is located on the ipsilateral submandibular gland (posterior and medial). The CT features of congenital piriform sinus fistula are that the focus is located on the dorsal side of the upper pole of the lateral lobe of the thyroid gland.
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Affiliation(s)
- 宜龙 周
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518100)Department of Children Otorhinolaryngology, Shenzhen Hospital, Southern Medical University, Shenzhen, 518000, China
| | - 伟 陈
- 上海市儿童医院 上海市交通大学医学院附属儿童医院耳鼻咽喉头颈外科Department of Otolaryngology Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao tong University
| | - 蓉 徐
- 上海市儿童医院 上海市交通大学医学院附属儿童医院影像科Department of Radiology and Medicine Imaging, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao tong University
| | - 佳瑞 陈
- 上海市儿童医院 上海市交通大学医学院附属儿童医院耳鼻咽喉头颈外科Department of Otolaryngology Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao tong University
| | - 晓艳 李
- 上海市儿童医院 上海市交通大学医学院附属儿童医院耳鼻咽喉头颈外科Department of Otolaryngology Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao tong University
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22
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Widodo DW, Anatriera RA, Tunggadewi AP, Yunus RE. Recurrent preauricular fistula surgery guided by fistulography. Journal of Pediatric Surgery Case Reports 2022; 81:102294. [DOI: 10.1016/j.epsc.2022.102294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Brad Hall A, Hasara S, Coker P. Identification of a branchial cleft anomaly via handheld point-of-care ultrasound. J Ultrason 2022; 22:e67-e69. [PMID: 35449698 PMCID: PMC9009347 DOI: 10.15557/jou.2022.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/10/2021] [Indexed: 11/22/2022] Open
Abstract
Aim of the study Branchial anomalies result from incomplete obliteration of the branchial arch structures during embryogenesis. Second branchial arch anomalies are commonly found on the lower third of the neck, with an opening at the anterior border of the sternocleidomastoid muscle, and may drain secretions or purulent material. This case demonstrates the use of handheld point-of-care ultrasound to aid in the diagnosis of a branchial anomaly. Case description The patient presented with a “hole” in the neck with intermittent drainage from the site. A 2 mm defect in the skin was noted anterior to the sternocleidomastoid muscle. A handheld ultrasound system was used to identify a well-defined, hypoechoic, cyst-like structure. Given the history, physical findings, and point-of-care ultrasound imaging, the diagnosis of a second branchial cleft sinus was made. Conclusions The use of point-of-care ultrasound and knowledge of the sonographic characteristics of these lesions can assist the physician in the diagnosis of branchial arch anomalies.
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Affiliation(s)
- A Brad Hall
- Morsani College of Medicine, University of South Florida, United States
| | | | - Phillip Coker
- Emergency Medicine, Lakeland Regional Health, United States
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24
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Frazer JB, Davies DA, Langley JM. Infected branchial cleft cyst in a newborn. Journal of Pediatric Surgery Case Reports 2022. [DOI: 10.1016/j.epsc.2022.102275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Erwin DZ, Lesko D, Ferrell JK. Recurrent Neck Mass: A Case Report. Cureus 2022; 14:e22098. [PMID: 35308767 PMCID: PMC8923046 DOI: 10.7759/cureus.22098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 12/02/2022] Open
Abstract
Fourth branchial cleft anomalies are an exceptionally rare cause of recurrent neck mass in pediatric and adult patients. In this report, we present a case of an infected fourth branchial cleft cyst in a 20-year-old woman that presented with recurrent throat pain and deep neck abscesses. After undergoing repeated incision and drainage procedures, the patient underwent definitive management with direct laryngoscopy, ablation of the left pyriform sinus tract, left hemithyroidectomy, and excision of the branchial anomaly without evidence of recurrence. In addition to diagnosis and management, this case report highlights the unique anatomical relationship between fourth branchial anomalies and the pyriform fossa as well as the superior and recurrent laryngeal nerves.
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Chaturvedi HT, Chaturvedi C. Branchial cleft cyst associated with xanthogranulomatous inflammation – An unusual case. Ann Maxillofac Surg 2022; 12:79-82. [PMID: 36199456 PMCID: PMC9527843 DOI: 10.4103/ams.ams_225_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/01/2022] [Accepted: 02/16/2022] [Indexed: 11/04/2022] Open
Abstract
Rationale: Patient Concerns: Diagnosis: Treatment: Outcomes: Take-away Lessons:
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27
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Chen W, Xu M, Wang Q, Xu H, Chen J, Li X. Pediatric bronchogenic cysts in the head and neck region: A study of 10 surgical cases and a review of the literature. Front Pediatr 2022; 10:1030692. [PMID: 36405846 PMCID: PMC9671707 DOI: 10.3389/fped.2022.1030692] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To explore the clinical characteristics and surgical treatment of children with bronchogenic cysts (BCs) in the head and neck region. METHODS A retrospective study of 10 pediatric patients with BCs in the head and neck region treated in Shanghai Children's Hospital during 2011 to 2022 was performed. RESULTS Based on their pathological diagnosis, 10 patients with BCs in the head and neck were identified. The most common location was the neck (8 patients, 80%; 2 midline neck, 6 lateral neck), followed by the ventral tip of tongue (1 patient), and the posterior pharyngeal wall (1 patient). Misdiagnosed as lymphangioma in 5 cases, cyst in 3 cases, thyroglossal duct cyst (TGDC) in 2 cases and congenital pyriform sinus fistula (CPSF) in 1 case preoperative. The median follow-up period after surgery was 4.68 (range, 0.67-9.25) years. All 10 patients underwent complete resection without recurrence or other complications. CONCLUSIONS Although extremely rare, BCs should be considered in the differential diagnosis of midline and lateral neck masses or intraoral cysts in children. Surgical excision is recommended in BCs, and the diagnosis is definitively confirmed by histopathology.
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Affiliation(s)
- Wei Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - MengRou Xu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qingyu Wang
- Department of Pathology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hongming Xu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiarui Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyan Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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PupiĆ-Bakrač J. In Reference to Analysis of the Clinical Features and Surgical Outcomes of First Branchial Cleft Anomalies. Laryngoscope 2021; 132:E14. [PMID: 34913496 DOI: 10.1002/lary.29989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Jure PupiĆ-Bakrač
- Department of Otorhinolaryngology and Maxillofacial Surgery, General Hospital Zadar, Zadar, Croatia
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29
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Ho ML. Pediatric Neck Masses: Imaging Guidelines and Recommendations. Radiol Clin North Am 2021; 60:1-14. [PMID: 34836558 DOI: 10.1016/j.rcl.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Neck masses commonly present in children and several potential diagnostic and management pathways exist, though with a paucity of evidence-based recommendations. The purpose of this article is to evaluate the current literature and utilization of various diagnostic imaging modalities , with a review of imaging features and management pearls for pediatric neck masses. A comprehensive understanding and practical imaging workflow will guide optimal patient workup and management.
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Affiliation(s)
- Mai-Lan Ho
- Department of Radiology, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive - ED4, Columbus, OH 43205, USA.
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Boonen A, Hens G, Meulemans J, Hermans R, Delaere P, Vander Poorten V. Fourth Branchial Anomalies: Diagnosis, Treatment, and Long-Term Outcome. Front Surg 2021; 8:748351. [PMID: 34651012 PMCID: PMC8505890 DOI: 10.3389/fsurg.2021.748351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Fourth branchial anomalies, the rarest among anomalies of the branchial apparatus, often present diagnostic and therapeutic challenges. We evaluated the clinical presentation and radiographic features, the treatment and the long-term outcome of patients in this setting. Patients and Methods: Of 12 patients treated in the University Hospitals Leuven from 2004 until 2020, 12 variables were collected: date of birth, gender, age of onset of the symptoms, age at final diagnosis, presentation, laterality, previous procedures, diagnostic tools, treatment (open neck surgery, endoscopic laser excision, or combination), complications, recurrence, and period of follow-up. Descriptive statistics were calculated and results were compared to the existing literature. Results: The most common clinical manifestations were recurrent neck infections with and without abcedation. Definitive diagnosis using direct laryngoscopy, visualizing the internal sinus opening, was possible in all patients. A CT study revealed the typical features of fourth branchial anomalies in seven patients out of nine, an ultrasound study in five out of nine patients. All patients underwent open neck surgery. If this was insufficient, secondary endoscopic laser resection of the ostium at the apex of the piriform sinus was performed (n = 4). In eight patients a thyroid lobectomy was needed for safe complete resection. Postoperative complications were minimal and at long-term, none of the patients showed further recurrence. Average time of follow-up was 8.6 years. Conclusions: Direct laryngoscopy and CT are the most accurate diagnostic tools. Our recommended treatment schedule consists of complete excision of the sinus tract by open neck surgery as the primary treatment because this ensures the best results. In case of recurrence afterwards, endoscopic laser resection of the pharyngeal ostium solved the problem.
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Affiliation(s)
- Annelien Boonen
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Greet Hens
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jeroen Meulemans
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Robert Hermans
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Pierre Delaere
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
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Huysseune A, Cerny R, Witten PE. The conundrum of pharyngeal teeth origin: the role of germ layers, pouches, and gill slits. Biol Rev Camb Philos Soc 2021; 97:414-447. [PMID: 34647411 PMCID: PMC9293187 DOI: 10.1111/brv.12805] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/15/2022]
Abstract
There are several competing hypotheses on tooth origins, with discussions eventually settling in favour of an 'outside-in' scenario, in which internal odontodes (teeth) derived from external odontodes (skin denticles) in jawless vertebrates. The evolution of oral teeth from skin denticles can be intuitively understood from their location at the mouth entrance. However, the basal condition for jawed vertebrates is arguably to possess teeth distributed throughout the oropharynx (i.e. oral and pharyngeal teeth). As skin denticle development requires the presence of ectoderm-derived epithelium and of mesenchyme, it remains to be answered how odontode-forming skin epithelium, or its competence, were 'transferred' deep into the endoderm-covered oropharynx. The 'modified outside-in' hypothesis for tooth origins proposed that this transfer was accomplished through displacement of odontogenic epithelium, that is ectoderm, not only through the mouth, but also via any opening (e.g. gill slits) that connects the ectoderm to the epithelial lining of the pharynx (endoderm). This review explores from an evolutionary and from a developmental perspective whether ectoderm plays a role in (pharyngeal) tooth and denticle formation. Historic and recent studies on tooth development show that the odontogenic epithelium (enamel organ) of oral or pharyngeal teeth can be of ectodermal, endodermal, or of mixed ecto-endodermal origin. Comprehensive data are, however, only available for a few taxa. Interestingly, in these taxa, the enamel organ always develops from the basal layer of a stratified epithelium that is at least bilayered. In zebrafish, a miniaturised teleost that only retains pharyngeal teeth, an epithelial surface layer with ectoderm-like characters is required to initiate the formation of an enamel organ from the basal, endodermal epithelium. In urodele amphibians, the bilayered epithelium is endodermal, but the surface layer acquires ectodermal characters, here termed 'epidermalised endoderm'. Furthermore, ectoderm-endoderm contacts at pouch-cleft boundaries (i.e. the prospective gill slits) are important for pharyngeal tooth initiation, even if the influx of ectoderm via these routes is limited. A balance between sonic hedgehog and retinoic acid signalling could operate to assign tooth-initiating competence to the endoderm at the level of any particular pouch. In summary, three characters are identified as being required for pharyngeal tooth formation: (i) pouch-cleft contact, (ii) a stratified epithelium, of which (iii) the apical layer adopts ectodermal features. These characters delimit the area in which teeth can form, yet cannot alone explain the distribution of teeth over the different pharyngeal arches. The review concludes with a hypothetical evolutionary scenario regarding the persisting influence of ectoderm on pharyngeal tooth formation. Studies on basal osteichthyans with less-specialised types of early embryonic development will provide a crucial test for the potential role of ectoderm in pharyngeal tooth formation and for the 'modified outside-in' hypothesis of tooth origins.
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Affiliation(s)
- Ann Huysseune
- Research Group Evolutionary Developmental Biology, Biology Department, Ghent University, K.L. Ledeganckstraat 35, Ghent, B-9000, Belgium
| | - Robert Cerny
- Department of Zoology, Faculty of Science, Charles University, Vinicna 7, Prague, 128 44, Czech Republic
| | - P Eckhard Witten
- Research Group Evolutionary Developmental Biology, Biology Department, Ghent University, K.L. Ledeganckstraat 35, Ghent, B-9000, Belgium
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Pupić-Bakrač J, Skitarelić N, Novaković J, Lasić V. Patho-Anatomic Spectrum of Branchial Cleft Anomalies: Proposal of Novel Classification System. J Oral Maxillofac Surg 2021; 80:341-348. [PMID: 34648755 DOI: 10.1016/j.joms.2021.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Histogenesis, nomenclature, and classification of branchial cleft anomalies (BCAs) have been subjects of controversy for decades. The purpose of this study was to investigate the accuracy of current developmental theories (congenital, lymph node, and hybrid branchial inclusion theories) in defining the anatomic and histopathological characteristics of BCAs. METHODS Ninety consecutive patients with BCAs who underwent surgical excision were enrolled in this 2-center retrospective cohort study. RESULTS The present study included 90 patients: 46 (51.11%) women and 44 (48.89%) men (P > .05). The mean age at presentation was 31.89±17.31 years. Altogether, 92 BCAs were identified within the study population including 49 (53.26%) on the left side and 43 (46.74%) on the right side (P > .05). The BCAs included 79 (85.87%) branchial cleft cysts, 11 (11.96%) branchial cleft sinuses, and 2 (2.17%) branchial cleft fistulae. Three (3.26%) BCAs were distributed in the head regions, 88 (95.65%) in the neck regions, and 1 (1.09%) in the thoracic cavity. Following surgery, lymphoepithelial tissue was detected in the histopathological examination in 83 (90.22%) BCAs. The hybrid branchial inclusion theory exhibited significantly higher accuracy in defining patho-anatomic characteristics of BCAs than the branchial apparatus, precervical sinus, thymopharyngeal, and inclusion theories (90.22, 9.78, 2.17, 0.00, and 0.00%; respectively) (P < .05). CONCLUSION The novel branchial node (BN) classification system based on the hybrid branchial inclusion theory appears to be superior to other classification systems in determining the patho-anatomy of BCAs.
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Affiliation(s)
- Jure Pupić-Bakrač
- Resident, Department of Otorhinolaryngology and Maxillofacial Surgery, General Hospital Zadar, Zadar, Croatia
| | - Neven Skitarelić
- Resident, Department of Otorhinolaryngology and Maxillofacial Surgery, General Hospital Zadar, Zadar, Croatia; Professor, Department of Health Studies, University of Zadar, Zadar, Croatia; Professor, Faculty of Medicine, University of Rijeka, Rijeka, Croatia; Department Head, Department of Otorhinolaryngology and Maxillofacial Surgery, General Hospital Zadar, Zadar, Croatia.
| | - Josip Novaković
- Physician Associate, Department of Otorhinolaryngology and Maxillofacial Surgery, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Valentina Lasić
- Resident, Department of Pediatric Surgery, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
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Xian Z, Chen Y, Teng Y, Han S, Li L. Second branchial cleft cyst with snoring during sleep as initial symptom: A case report and literature review. Medicine (Baltimore) 2021; 100:e27037. [PMID: 34449485 PMCID: PMC8389974 DOI: 10.1097/md.0000000000027037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/10/2021] [Indexed: 01/04/2023] Open
Abstract
The second branchial cleft cyst lacks typical symptoms, and its clinical manifestations are complex and varied. Among them, the second branchial cleft cyst manifested by sleep snoring is relatively rare, and it can easily lead to missed diagnosis or misdiagnosis. This paper reports a case of a second branchial cleft abscess with snoring as the main manifestation. The branchial cleft cyst was removed using an endoscopic branchial cleft.
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Cordes M, Coerper S, Kuwert T, Schmidkonz C. Ultrasound Imaging of Cervical Anatomic Variants. Curr Med Imaging 2021; 17:966-972. [PMID: 33504311 PMCID: PMC8653420 DOI: 10.2174/1573405617666210127162328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 11/30/2022]
Abstract
Embryologic developmental variants of the thyroid and parathyroid glands may cause cervical anomalies that are detectable in ultrasound examinations of the neck. For some of these developmental variants, molecular genetic factors have been identified. Ultrasound, as the first-line imaging procedure, has proven useful in detecting clinically relevant anatomic variants. The aim of this article was to systematically summarize the ultrasound characteristics of developmental variants of the thyroid and parathyroid glands as well as ectopic thymus and neck cysts. Quantitative measures were developed based on our findings and the respective literature. Developmental anomalies frequently manifest as cysts that can be detected by cervical ultrasound examinations. Median neck cysts are the most common congenital cervical cystic lesions, with a reported prevalence of 7% in the general population. Besides cystic malformations, developmental anomalies may appear as ectopic or dystopic tissue. Ectopic thyroid tissue is observed in the midline of the neck in most patients and has a prevalence of 1/100,000 to 1/300,000. Lingual thyroid accounts for 90% of cases of ectopic thyroid tissue. Zuckerkandl tubercles (ZTs) have been detected in 55% of all thyroid lobes. Prominent ZTs are frequently observed in thyroid lobes affected by autoimmune thyroiditis compared with normal lobes or nodular lobes (P = 0.006). The correct interpretation of the ultrasound characteristics of these variants is essential to establish the clinical diagnosis. In the preoperative assessment, the identification of these cervical anomalies via ultrasound examination is indispensable.
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Affiliation(s)
- Michael Cordes
- Nuklearmedizinische Klinik, Universitätsklinikum Erlangen, Germany
| | - Stephan Coerper
- Klinik für Chirurgie, Martha-Maria-Krankenhaus, Nürnberg, Germany
| | - Torsten Kuwert
- Nuklearmedizinische Klinik, Universitätsklinikum Erlangen, Germany
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Fanous A, Morcrette G, Fabre M, Couloigner V, Galmiche-Rolland L. Diagnostic Approach to Congenital Cystic Masses of the Neck from a Clinical and Pathological Perspective. Dermatopathology (Basel) 2021; 8:342-58. [PMID: 34449578 DOI: 10.3390/dermatopathology8030039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND neck cysts are frequently encountered in pediatric medicine and can present a diagnostic dilemma for clinicians and pathologists. Several clinical items enable to subclassify neck cyst as age at presentation, anatomical location, including compartments and fascia of the neck, and radiological presentation. SUMMARY this review will briefly describe the clinical, imaging, pathological and management features of (I) congenital and developmental pathologies, including thyroglossal duct cyst, branchial cleft cysts, dermoid cyst, thymic cyst, and ectopic thymus; (II) vascular malformations, including lymphangioma. Key Messages: pathologists should be familiar with the diagnostic features and clinicopathologic entities of these neck lesions in order to correctly diagnose them and to provide proper clinical management.
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Meijers S, Meijers R, van der Veen E, van den Aardweg M, Bruijnzeel H. A Systematic Literature Review to Compare Clinical Outcomes of Different Surgical Techniques for Second Branchial Cyst Removal. Ann Otol Rhinol Laryngol 2021; 131:435-444. [PMID: 34137276 PMCID: PMC8899809 DOI: 10.1177/00034894211024049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objective: During the last 2 decades, new treatment methods have been developed for the
surgical removal of second branchial cysts which result in less visible
scars. The aim of this systematic review is to assess which surgical
technique for second branchial arch cyst removal results in the lowest
complication and recurrence rates with the highest scar satisfaction. Methods: Two authors systematically reviewed the literature in the Cochrane, PubMed,
and EMBASE databases (search date: 1975 to December 2nd, 2020) to identify
studies comparing surgical outcomes of second branchial arch cyst removal.
Authors appraised selected studies on directness of evidence and risk of
bias. Results are reported according to Preferred Reporting Items for
Systematic Reviews and Meta-Analyses statement. Results: Out of the 2442 retrieved articles, 4 articles were included in the current
review including a total of 140 operated cysts. Only 2 studies included
pre-operatively infected cysts. Follow up ranged from 3 to 24 months.
Complication rates ranged from 0 to 27.3% (conventional: [0–10.4%];
endoscopic/retro-auricular: [0–27.3%]). None of the patients presented with
postoperative recurrence. Significantly higher scar satisfaction was found
in adult patients who underwent endoscopic or retro-auricular hairline
incision cyst removal. Conclusion: No recurrence of disease occurred during (at least) 3 months of follow up
using either conventional surgery or endoscopic/retro-auricular techniques.
Although more (temporary) complications occur using endoscopic and
retro-auricular techniques, patients report a significantly higher scar
satisfaction 3 to 6 months after surgery in comparison to the conventional
technique. Future studies are needed to support these findings.
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Affiliation(s)
- Sebastiaan Meijers
- Department of Otorhinolaryngology and
Head and Neck Surgery, University Medical Center Utrecht, the Netherlands
| | - Rutger Meijers
- Department of Neurology, Radboud
University Medical Center, Nijmegen, The Netherlands
| | - Erwin van der Veen
- Department of Otorhinolaryngology and
Head and Neck Surgery, University Medical Center Utrecht, the Netherlands
- Central Military Hospital, Utrecht, The
Netherlands
| | - Maaike van den Aardweg
- Department of Otorhinolaryngology and
Head and Neck Surgery, Rivierenland Hospital, Tiel, The Netherlands
| | - Hanneke Bruijnzeel
- Department of Otorhinolaryngology and
Head and Neck Surgery, University Medical Center Utrecht, the Netherlands
- Brain Center Rudolf Magnus, Utrecht,
The Netherlands
- Hanneke Bruijnzeel, MD, PhD, Department of
Otolaryngology and Head and Neck Surgery, Utrecht Medical Center, Heidelberglaan
100, Utrecht 3584 CX, The Netherlands.
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Ragab A, Hussein HA. Endoscopic combined transcervical-transoral second branchial fistulectomy: A novel technique with prospective case series. Int J Pediatr Otorhinolaryngol 2021; 145:110668. [PMID: 33895397 DOI: 10.1016/j.ijporl.2021.110668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/18/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To describe and assess a novel technique of complete endoscopic combined transcervical-transoral fistulectomy (ECCOF) in the management of pediatric complete second branchial cleft (BC) fistula tracts (SBCFTs). METHODS A prospective single-center consecutive case series of SBCFTs was designed. Course and angles of inclination of the tract towards the pharyngeal wall were assessed using CT fistulography. Complete endoscopic fistulectomy was performed using three levels of dissection via ECCOF. Technique, advantages, complications and recurrences were assessed. RESULTS Five children with a mean age of 4.1 ± 0.96 years and seven SBCFTs were included. Four were left-sided fistulae (57.2%), while three were right-sided fistulae (42.8%). The average angle of deep inclination of the fistula tracts between the first and second parts of the fistula tracts (at the carotid bifurcation) was 143.57 ± 10.92°. Complete visualization with safe dissection in all three levels of ECCOF was obtained for all fistulae. No recurrence or complications were observed with an average follow-up of 35.85 ± 22.13 months. CONCLUSION Endoscopic management of SBCFTs appears to be effective and safe. It avoids the prerequisite for wide or double incisions and enables an excellent view of the surrounding structures, which leads to fewer complications and recurrences.
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Affiliation(s)
- Ahmed Ragab
- Department of Otorhinolaryngology, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
| | - Hossam Adel Hussein
- Department of Otorhinolaryngology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
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Konstantinidou S, Wyatt M, Butler C, Frauenfelder C. Bilobed tongue base associated with multiple branchial anomalies. BMJ Case Rep 2021; 14:e241081. [PMID: 33782069 PMCID: PMC8009237 DOI: 10.1136/bcr-2020-241081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2021] [Indexed: 11/03/2022] Open
Abstract
A bilobed tongue base was identified in an infant with multiple other head, neck and cardiac congenital anomalies. This anatomical variation of the posterior tongue is rare, with only two other cases identified in the literature. We report a case of a 5-month-old boy with a bilobed posterior tongue incidentally identified during workup for cardiac surgery.
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Affiliation(s)
| | - Michelle Wyatt
- Paediatric Otolaryngology, Great Ormond Street Hospital for Children, London, UK
| | - Colin Butler
- Paediatric Otolaryngology, Great Ormond Street Hospital for Children, London, UK
- University College London, Institute of Child Health, Londond, UK
| | - Claire Frauenfelder
- Paediatric Otolaryngology, Great Ormond Street Hospital for Children, London, UK
- Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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Pupić-Bakrač J, Skitarelić N, Pupić-Bakrač A, Baraka I, Srzentić M, Novaković J, Terkeš V. Branchial cleft anomalies: hybrid "Branchial Inclusion" theory. Eur Arch Otorhinolaryngol 2021; 278:2593-601. [PMID: 33427915 DOI: 10.1007/s00405-020-06551-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/04/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Branchial cleft anomalies (BCAs) are developmental malformations of the head and neck region. Their histogenesis has been the subject of controversy and is not fully understood. This study aimed to test all present developmental theories ("branchial apparatus," "precervical sinus," "thymopharyngeal," and "inclusion" theories) on a sample of 48 BCAs from a single institution. METHODS We performed a retrospective analysis of clinical-epidemiological and anatomical-pathological characteristics of BCAs treated over a 12-year period in our hospital. RESULTS Overall, 46 patients (24 [52.17%] women and 22 men [47.83%]) underwent surgical excision of 48 BCAs. The mean patient age at presentation was 31.65 ± 19.40 years. Branchial cleft cysts were found in 42 (87.50%) cases, and branchial cleft sinuses were found in six (12.50%) cases. Eight (16.67%) BCAs were distributed in the preauricular region, 34 (70.83%) at the anterior border of the sternocleidomastoid muscle (SCM), three (6.25%) at the posterior border of the SCM, two (4.17%) in the suprasternal notch, and one (2.08%) in the retrosternal space. Histopathologically, 39 (81.25%) BCAs had a lymphoepithelial structure and nine (18.75%) BCAs had solitary epithelial cells. Inflammation and infection were observed in 24 (50%) and 12 (25%) cases, respectively. CONCLUSION None of the hypothesized developmental theories fully explain the embryonic origin of BCA in our study sample. A possible explanation of BCA histogenesis is through the hybrid "branchial inclusion" theory.
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40
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Reis J 3rd, Koo KSH, Monroe EJ, Shivaram GM, Otjen JP, Tang ER, Iyer RS. Ultrasound Evaluation of Pediatric Slow-Flow Vascular Malformations: Practical Diagnostic Reporting to Guide Interventional Management. AJR Am J Roentgenol 2021; 216:494-506. [PMID: 33356433 DOI: 10.2214/AJR.20.23338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE. This article reviews the ultrasound characteristics of pediatric slow-flow vascular malformations and underscores findings that significantly impact diagnosis and treatment. Key imaging features are discussed including lesion size, malformation location, morphology, and mimics. CONCLUSION. Ultrasound findings affect the management of slow-flow vascular malformations and should be emphasized in lesion diagnosis. Superficial, focal lesions with well-defined margins are ideal for ultrasound evaluation.
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Pool C, Ehret C, Engle L, Zhu J, Wilson MN. Feasibility of same day surgery for pediatric second branchial cleft anomalies. Int J Pediatr Otorhinolaryngol 2020; 139:110402. [PMID: 33017666 DOI: 10.1016/j.ijporl.2020.110402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The risk of expansile hematoma and airway compromise following neck surgery have been used to validate overnight observation. We investigated the outcomes of pediatric patients undergoing a removal of second branchial cleft anomalies (BCA) via either same day surgery or overnight observation. METHODS A retrospective review of patients undergoing second BCA removal between January 1, 2008 to January 1, 2019 was performed. 40 cases were identified for review. Bivariate analyses were performed to determine predictive factors for overnight admission as well as associations between overnight observation and adverse outcomes (hematoma, seroma, airway compromise, infection). Factors evaluated for analysis included ASA class, surgeon type, history of pre-operative infection, recurrent case, operation >90 min, pharyngeal violation, intraoperative cyst rupture, cyst size, and drain placement. RESULTS There were no life-threatening adverse events. Same day discharge was not associated with adverse events (p = 0.24). Overnight observation was associated with a history of preoperative infection (p = 0.003), cyst > 3.0 cm (p = 0.046), operative time > 90 min (p < 0.001), and drain placement (p = 0.001). There was no association between other investigated variables and adverse events or overnight stay. CONCLUSION Same day discharge following second branchial cleft anomalies appears safe and feasible. Further study is needed to determine the safety profile of same day discharge and etiologies of practice patterns of overnight observation.
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Affiliation(s)
- Christopher Pool
- Penn State Hershey Medical Center, Department of Otolaryngology - Head and Neck Surgery, USA
| | | | - Linda Engle
- Penn State Hershey Medical Center, Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, USA
| | - Junjia Zhu
- Penn State Hershey Medical Center, Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, USA
| | - Meghan N Wilson
- Penn State Hershey Medical Center, Department of Otolaryngology - Head and Neck Surgery, USA.
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Nutcharoen AA, Kim DD, Volio AE, Skolaris AT, Bhatnagar N, Ayad SS. Large branchial arch cyst excision using superficial and deep cervical plexus blocks in a patient with severe comorbidities. Anaesth Rep 2020; 8:187-190. [PMID: 33283191 DOI: 10.1002/anr3.12066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2020] [Indexed: 11/07/2022] Open
Abstract
Branchial arches are embryologic structures that develop between the fourth and seventh gestational week. Anomalies may form if these structures fail to develop. The majority of cases are diagnosed during childhood, with surgical excision recommended to prevent risk of infection, growth or malignancy. We report an unusual case of a 72-year-old man with severe cardiac comorbidities who presented with a large second branchial arch cyst extending into the oropharynx. General anaesthesia to facilitate surgical excision was deemed too risky. Therefore, we performed successful ultrasound-guided superficial and deep cervical plexus blocks as a sole mode of anaesthesia. This case highlights how regional anaesthesia can be utilised to facilitate surgery in high-risk patients, as well as presenting an alternative for general anaesthesia.
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Affiliation(s)
- A A Nutcharoen
- Outcomes Research Cleveland Clinic Fairview Hospital Cleveland OH USA
| | - D D Kim
- Outcomes Research Cleveland Clinic Fairview Hospital Cleveland OH USA
| | - A E Volio
- Outcomes Research Cleveland Clinic Fairview Hospital Cleveland OH USA
| | - A T Skolaris
- Outcomes Research Cleveland Clinic Fairview Hospital Cleveland OH USA
| | - N Bhatnagar
- Outcomes Research Cleveland Clinic Fairview Hospital Cleveland OH USA
| | - S S Ayad
- Outcomes Research Cleveland Clinic Fairview Hospital Cleveland OH USA
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Maksimoski M, Maurrasse SE, Purkey M, Maddalozzo J. Combination Surgical Procedure for Fourth Branchial Anomalies: Operative Technique and Outcomes. Ann Otol Rhinol Laryngol 2020; 130:738-744. [PMID: 33158383 DOI: 10.1177/0003489420971674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Branchial apparatus anomalies of the fourth cleft are the rarest subtype of anomaly and occasionally present with suppurative thyroiditis or thyroid abscess due to their relationship with the thyroid gland. Surgical approaches vary and some surgeons favor cauterization of associated pyriform sinus tracts alone versus complete surgical excision. Currently, the literature is scarce and there is limited data on surgical outcomes and procedural steps. Here we describe a combination surgical technique for fourth branchial anomalies including: (1) surgical excision of the cyst and any external pit, (2) hemithyroidectomy, and (3) direct laryngoscopy with cauterization of pyriform apex tract, if present. METHODS A retrospective review was performed on all patients who underwent surgical excision of fourth branchial apparatus lesions (including fistulae, cysts, and sinus tracts) at an urban pediatric university hospital from 2000 to 2019. Data regarding demographics, medical history, surgical methods, complications, and surgical cure rates were collected. RESULTS A total of 16 patients (9 female, 7 male) underwent a combination surgical procedure for fourth branchial apparatus lesions. Success rate after primary surgery was 94%. One patient had residual disease requiring re-operation. Two patients had post-operative complications: 1 transient vocal fold paresis and 1 seroma, both managed conservatively. A consensus surgical algorithm was created based on operative steps present in the majority of cases. CONCLUSION A combination approach to fourth branchial apparatus lesions-including endoscopic cauterization, external excision, and hemithyroidectomy-is safe and provides a high rate of primary cure. Although less invasive options exist, remnants of the branchial lesion, especially in the thyroid, may remain and cause recurrent issues. Therefore, we advocate for complete surgical excision of this rare developmental anomaly, especially when obvious thyroid involvement exists.
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Affiliation(s)
- Matthew Maksimoski
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sarah E Maurrasse
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Matthew Purkey
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John Maddalozzo
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Laababsi R, Elbouhmadi K, Bouzbouz A, Oukessou Y, Rouadi S, Abada R, Roubal M, Mahtar M. Misdiagnosed pyriform sinus fistula revealed by iterative neck abscesses: A case report and review of the literature. Ann Med Surg (Lond) 2020; 59:64-67. [PMID: 32994985 PMCID: PMC7501404 DOI: 10.1016/j.amsu.2020.08.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/29/2020] [Accepted: 08/30/2020] [Indexed: 10/31/2022] Open
Abstract
The pyriform sinus fistula is a rare condition described as an epithelialized tract connecting the skin of the neck to the foregut, and may result in cervical cysts and iterative abscesses misleading the diagnosis. The clinical and radiological examinations are all useful. Surgery stands as one of the most effective therapeutic options consisting on the total excision on the eventual cyst, and the fistula that is followed to its inner opening on the pyriform sinus. We present a case of a 3-years-old boy with a pyriform sinus fistula that caused recurrent neck abscesses treated independently delaying the diagnosis. Once in our structure, after radiological examination and antibiotics to cool the infection down, the surgery removed the cyst with its tract that opened in the pyriform sinus. The follow up showed an effective result with the total disappearance of the lesion with no more infectious episodes. Even if it's a rare condition, the diagnosis of apyriform sinus fistula must be considered in front of every patient with a history of recurrentlatero cervical abscess.
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Affiliation(s)
- Rabii Laababsi
- ENT Department, Face and Neck Surgery, Hospital August, 20'1953, University Hospital Centre IBN ROCHD, Casablanca, Morocco
| | - Khadija Elbouhmadi
- ENT Department, Face and Neck Surgery, Hospital August, 20'1953, University Hospital Centre IBN ROCHD, Casablanca, Morocco
| | - Anas Bouzbouz
- ENT Department, Face and Neck Surgery, Hospital August, 20'1953, University Hospital Centre IBN ROCHD, Casablanca, Morocco
| | - Youssef Oukessou
- ENT Department, Face and Neck Surgery, Hospital August, 20'1953, University Hospital Centre IBN ROCHD, Casablanca, Morocco
| | - Sami Rouadi
- ENT Department, Face and Neck Surgery, Hospital August, 20'1953, University Hospital Centre IBN ROCHD, Casablanca, Morocco
| | - Reda Abada
- ENT Department, Face and Neck Surgery, Hospital August, 20'1953, University Hospital Centre IBN ROCHD, Casablanca, Morocco
| | - Mohammed Roubal
- ENT Department, Face and Neck Surgery, Hospital August, 20'1953, University Hospital Centre IBN ROCHD, Casablanca, Morocco
| | - Mohammed Mahtar
- ENT Department, Face and Neck Surgery, Hospital August, 20'1953, University Hospital Centre IBN ROCHD, Casablanca, Morocco
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Abstract
Branchial cleft anomalies are embryonic remnants of the branchial arches and are described as the second most common congenital neck mass. Depending on their extent, these anomalies are classified as a cyst, sinus, or fistula with branchial cysts being the most common. Branchial cysts deriving from the second branchial arch are by far the most common, accounting for approximately 95% of all cases. Complete second branch arch fistulas with both an internal and external opening are a rare variant of this anomaly, and even less have been well-documented on computed tomography (CT) imaging in the literature. We present here a case of a 20-year-old female with CT findings consistent with a complete second branchial arch fistula extending from the tonsillar fossa to the external lateral neck.
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Affiliation(s)
- Jackson King
- Elson S. Floyd College of Medicine at 6760Washington State University, Spokane, WA, USA
| | - Brian Mitchell
- Columbia Surgical Associates, 49477Spokane ENT, Spokane, WA, USA
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D'Arco F, Ugga L. Computed tomography and magnetic resonance imaging in pediatric salivary gland diseases: a guide to the differential diagnosis. Pediatr Radiol 2020; 50:1293-1307. [PMID: 32556808 DOI: 10.1007/s00247-020-04684-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/09/2020] [Accepted: 04/16/2020] [Indexed: 12/12/2022]
Abstract
Salivary gland pathologies in children are frequent, particularly viral infections, but rarely need cross-sectional imaging. However, when a mass involves the salivary spaces (primarily or as a secondary invasion from other neck spaces) it may pose problems in the differential diagnosis and in immediate management. Infrequently, systemic autoimmune diseases can also involve the salivary parenchyma in children and correctly interpreting the constellation of findings in the whole body is critical for the diagnosis. Distinguishing between cystic and solid masses is the first step for radiologists in order to narrow down the diagnosis. Location and spatial extension are the most important elements differentiating cystic masses, while signal characteristics, internal structure and local invasion help in the differential diagnosis of solid masses.
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Affiliation(s)
- Felice D'Arco
- Department of Radiology, Neuroradiology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences,, University of Naples "Federico II", Naples, Italy
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47
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Abstract
Head and neck imaging is an intimidating subject for many radiologists because of the complex anatomy and potentially serious consequences of delayed or improper diagnosis of the diverse abnormalities involving this region. The purpose of this article is to help radiologists to understand the intricate anatomy of the head and neck and to review the imaging appearances of a variety of nontraumatic head and neck conditions that bring patients to the emergency department, including acute infectious and inflammatory diseases and acute complications of head and neck neoplasms. These conditions are presented in five sections on the basis of their primary location of involvement: the oral cavity and pharynx, neck, sinonasal tract, orbits, and ears. Important anatomic landmarks are reviewed briefly in each related section.Online supplemental material is available for this article.©RSNA, 2019.
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Affiliation(s)
- Shervin Kamalian
- From the Department of Radiology, Division of Emergency Radiology, Massachusetts General Hospital, 55 Fruit St, Blake SB Rm 0029A, Boston, MA 02114 (Shervin Kamalian, L.A., M.H.L., P.W.S., Shahmir Kamalian); and Department of Radiology, Massachusetts Eye and Ear Infirmary, Boston, Mass (H.D.C.)
| | - Laura Avery
- From the Department of Radiology, Division of Emergency Radiology, Massachusetts General Hospital, 55 Fruit St, Blake SB Rm 0029A, Boston, MA 02114 (Shervin Kamalian, L.A., M.H.L., P.W.S., Shahmir Kamalian); and Department of Radiology, Massachusetts Eye and Ear Infirmary, Boston, Mass (H.D.C.)
| | - Michael H Lev
- From the Department of Radiology, Division of Emergency Radiology, Massachusetts General Hospital, 55 Fruit St, Blake SB Rm 0029A, Boston, MA 02114 (Shervin Kamalian, L.A., M.H.L., P.W.S., Shahmir Kamalian); and Department of Radiology, Massachusetts Eye and Ear Infirmary, Boston, Mass (H.D.C.)
| | - Pamela W Schaefer
- From the Department of Radiology, Division of Emergency Radiology, Massachusetts General Hospital, 55 Fruit St, Blake SB Rm 0029A, Boston, MA 02114 (Shervin Kamalian, L.A., M.H.L., P.W.S., Shahmir Kamalian); and Department of Radiology, Massachusetts Eye and Ear Infirmary, Boston, Mass (H.D.C.)
| | - Hugh D Curtin
- From the Department of Radiology, Division of Emergency Radiology, Massachusetts General Hospital, 55 Fruit St, Blake SB Rm 0029A, Boston, MA 02114 (Shervin Kamalian, L.A., M.H.L., P.W.S., Shahmir Kamalian); and Department of Radiology, Massachusetts Eye and Ear Infirmary, Boston, Mass (H.D.C.)
| | - Shahmir Kamalian
- From the Department of Radiology, Division of Emergency Radiology, Massachusetts General Hospital, 55 Fruit St, Blake SB Rm 0029A, Boston, MA 02114 (Shervin Kamalian, L.A., M.H.L., P.W.S., Shahmir Kamalian); and Department of Radiology, Massachusetts Eye and Ear Infirmary, Boston, Mass (H.D.C.)
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Beichner TL, Speer B, Carpenter JW, Reavill DR. Surgical Management of an Intrathoracic Branchial Cyst in a Yellow-crested Cockatoo ( Cacatua sulphurea). J Avian Med Surg 2020; 33:289-295. [PMID: 31893625 DOI: 10.1647/2018-368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 40-year-old, female lesser crested cockatoo (Cacatua sulphurea) was presented with a complaint of hyporexia and sudden onset of sneezing and wheezing. Physical examination revealed mild stertorous inhalation, and the apex of the heart was palpable caudoventral to the distal tip of the sternum. Projection radiographic images showed a soft tissue mass displacing the heart and the thoracic portion of the trachea. A subsequent computed tomography series revealed a single, large, and predominantly encapsulated soft-tissue mass. The mass was contained within the cranial thoracic region and occupied most of the anatomic location of the thoracic portion of the clavicular air sac, extending around a portion of the trachea. A surgical exploratory procedure was performed, with a thoracic inlet thoracotomy, and the mass was found to be cystic and deeply attached to surrounding tissues at its caudal-most aspect. Complete excision was not possible, and the mass was drained and an incomplete resection was accomplished with approximately one-half of the cystic structure removed and submitted for histopathology. The mass was found to be benign, epithelial-lined, dense, fibrous connective tissue that would be consistent with a branchial cyst.
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Affiliation(s)
- Timothy L Beichner
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66505, USA
| | - Brian Speer
- The Medical Center for Birds, Oakley, CA 94561, USA
| | - James W Carpenter
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66505, USA
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49
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Schooler GR, Restrepo R, Mas RP, Lee EY. Congenital Incidental Findings in Children that Can Be Mistaken as True Pathologies in Adults. Radiol Clin North Am 2020; 58:639-652. [DOI: 10.1016/j.rcl.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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50
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Brucoli M, Boffano P, Benech A, Rosa S, Garzaro M, Aluffi Valletti P. Congenital nonvascular neck masses: a retrospective analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129:192-199. [DOI: 10.1016/j.oooo.2019.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 05/16/2019] [Accepted: 06/03/2019] [Indexed: 11/26/2022]
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