First branchial cleft anomalies in children: Experience with 30 cases

Abstract

First branchial cleft anomalies (FBCA) are rare in the clinical setting, as they account for 1 to 8% of all branchial abnormalities. The purpose of this study is to explore the relationship between the fistula tract and facial nerve and the surgical method of FBCA. This retrospective study included 30 cases of FBCA in children managed from 2009 to 2016. All patients underwent surgery to remove the tract of the FBCA. We reviewed the clinical data of the patients to obtain their demographics and management. Thirty patients (11 male and 19 female) with anomalies of FBCA were diagnosed. The ages ranged from 1 to 13 years (median, 3 years). Twenty cases had a close relationship with the parotid gland. The facial nerve was identified in 20 of the 30 patients. The tract ran deep to the facial nerve in 3 cases, superficial to it in 21 cases, and passed between the branches of the nerve in 6 cases. The facial nerve was not identified in ten patients, as the tract was superficial to it. There were 2 cases of postoperative temporary facial paralysis (2/30, 6.7%). The symptoms gradually improved after one month, 1 case had permanent facial paralysis (1/30, 3.3%), and 1 case had postoperative recurrence. Complete excision of the tract is the only way to manage FBCA, and the course of the tracts vary and have different relationships with the facial nerve. There are 3 types: Superficial, deep to the facial nerve, and between the branches of the nerve. Therefore, surgical approaches differ among the various types, and careful preoperative planning and protecting the facial nerve during resection of the tract are essential.

Keywords: anomaly; branchial cleft; children; facial nerve; surgery.

Figure 1.

First branchial cleft anomalies presenting as external openings of the tracts on the left mandibular angle and retroauricular groove.

Figure 2.

Computed tomography revealed a cystic lesion lay in the deep to the right parotid gland with a tract extending to the ear.

Figure 3.

Fistula tract lay superficial to the facial nerve. The facial nerve was not identified during the operation.

Figure 4.

Thick fistula tract lay deep to the facial nerve (arrow) and was in close contact with the left external auditory canal.

Figure 5.

Fistula tract lay between the branches of the nerve (arrow). Purulent discharge was found in the tract.

Figure 6.

Fistula tract was removed, and the trunk and each branch of the facial nerve (arrow) were identified.