J Korean Assoc Pediatr Surg.  2011 Dec;17(2):162-169.

Clinical Analysis of Second Branchial Cleft Anomalies in Children

• Lee JW
• Kim SH
• Kim HY
• Park KW
• Jung SE

Abstract

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

Keyword

Second branchial anomaly; Fistula; Sinus; Cyst; Children

MeSH Terms

Anti-Bacterial Agents
Branchial Region
Branchioma
Child
Craniofacial Abnormalities
Drainage
Epithelium
Female
Fistula
Follow-Up Studies
Head
Humans
Inflammation
Medical Records
Metaplasia
Neck
Pharyngeal Diseases
Physical Examination
Postoperative Complications
Recurrence
Retrospective Studies
Skin
Wound Infection
Anti-Bacterial Agents
Branchial Region
Craniofacial Abnormalities
Pharyngeal Diseases