Significance of the auditory meatus inferior wall cartilage in the surgical treatment of congenital first branchial cleft anomalies in children

Abstract

Objective: To investigate the clinical significance of the inferior wall cartilage of the auditory meatus in surgical treatment of congenital first branchial cleft anomalies (CFBCAs) in children.

Methods: Twenty children diagnosed with CFBCAs who underwent surgery between December 2018 and June 2022 at our hospital were retrospectively analyzed and classified according to their Work lesion type. The guiding significance of the inferior wall cartilage in the surgical treatment of CFBCAs was summarized by investigating the adjacent relationships of the surgical lesions with the external auditory canal and facial nerve.

Results: Of the 20 patients, 16 were classified as Work type I and 4 as Work type II. The lesions were adjacent to the inferior wall cartilage of the auditory meatus in all children. Work type I lesions were located in the upper lateral aspect and were not adjacent to the facial nerve. Work type II lesions were located in the inferior-medial region of the facial nerve. The lesions were completely resected in all children. One patient experienced recurrence 3 months postoperatively because of a residual endochondral fistula. No patients developed facial paralysis or other complications.

Conclusions: The inferior wall cartilage of the auditory meatus may help to the identify the initial lesion of the CFBCAs and can be regarded as a guiding anatomical structure. These lesions can be completely resected. For resection of Work type II first branchial cleft lesions, the surgical incision can be narrower, and can be precisely positioned with the assistance of endoscope.

Keywords: Congenital Abnormalities; Otorhinolaryngologic Diseases.

Figure 1

(A-C) For a Work type I cyst, a fusiform incision was made directly under direct visualization, exposing the inferior wall cartilage of the ear canal (arrow). (D-F) For Work type I fistula, a fusiform incision around the external fistula opening is used to incise the cartilage of the inferior wall of the ear canal (up arrow), and the bottom of the fistula is visible (down arrow). (G-I) For a Work type II cyst, a fusiform incision was made along the external orificium fistula, and a 0° endoscope was introduced horizontally into the mandibular angle. With the assistance of the endoscope, the end of the fistula was found at the cartilage of the lower wall of the ear canal (arrow).

Figure 2

(A) The left external auditory canal can be seen in the inward downward hypoechoic, and the bottom of the lesion is the cartilage of the lower wall of the EAC (arrow); (B,C) he gas/liquid dark area can be seen posterolateral to the left parotid region, with an obvious annular enhancement at the margin, and the lower wall of the EAC at the bottom of the lesion (indicated by the arrow in C). (D) A cyst-like long T2 signal (arrow) was displayed in the medial aspect of the left parotid gland, lateral to the carotid sheath, with the outer edge close to the left parotid gland. EAC, the external auditory canal.

Figure 3

The anatomical relationship of CFBCAs to surrounding tissues. CFBCAs was below the external auditory canal, in front of the mastoid, behind the parotid, and the bottom of CFBCAs was located in the auditory meatus inferior wall cartilage. CFBCAs, congenital first branchial cleft anomalies; EAC, the external auditory canal.

Figure 4

The cartilage of the inferior wall of EAC was dissected in the second operation of the recurrent patient, and residual fistula tissue is seen (arrow). EAC: the external auditory canal.