Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Apr:129:111184.
doi: 10.1016/j.ijscr.2025.111184. Epub 2025 Mar 24.

Second branchial cleft anomalies: Surgical management and long-term outcomes in a pediatric case series

Jihène Houas  1 , Monia Ghammam  2 , Taissir Ben Arfi  2 , Imen Boukattaya  2 , Wassim Kermani  2 , Mohamed Abdelkefi  2
Affiliations

Second branchial cleft anomalies: Surgical management and long-term outcomes in a pediatric case series

Jihène Houas et al. Int J Surg Case Rep. 2025 Apr.

Abstract

Introduction and importance: Second branchial cleft anomalies are common congenital malformations in children, presenting as cysts, fistulas, or cervical masses. Early detection and timely management are crucial to prevent complications such as superinfection. This study evaluates the clinical presentation, surgical treatment, and long-term outcomes of second branchial cleft anomalies in pediatric patients.

Case series presentation: We retrospectively reviewed 16 children treated for lateral cervical cysts and fistulas at our ENT department between January 2005 and December 2020. Of these, 10 had second branchial cleft anomalies, with a mean age of 8 years and a female predominance (80 %). Common presenting symptoms included cervical swelling, fistulas, and superinfection. Diagnostic approaches included ultrasound, CT, and auditory evoked potentials. Surgical excision of the cyst and fistula was performed in all cases.

Clinical discussion: Ultrasound was the primary diagnostic tool, followed by CT for detailed anatomical assessment. Surgical excision, including complete removal of the cyst and fistula, was performed. High ligation of the fistula, rather than ipsilateral tonsillectomy, was sufficient to prevent recurrence, with no cases of recurrence observed during the follow-up period.

Conclusion: Second branchial cleft anomalies in children require early diagnosis and surgical excision to avoid complications. High ligation of the fistula is an effective treatment to prevent recurrence, supporting the approach of complete excision without the need for tonsillectomy.

Keywords: Branchial cleft anomalies; Case series; Fistula; Recurrence prevention; Second branchial cleft cyst; Surgery.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest statement None.

Figures

Fig. 1
Fig. 1
A - Isolated non-productive right latero-cervical fistula in a child with a second branchial cleft anomaly (blue arrow). B - Low right latero-cervical swelling in a patient with a non-infected second branchial cleft cyst (red arrow). C - 2 cm basi-cervical swelling with purulent discharge through a fistulous opening in a patient with a complete second branchial cleft anomaly (orange arrow).
Fig. 2
Fig. 2
A cervical ultrasound showing a right lateral cervical cystic formation consistent with a second branchial cleft cyst.
Fig. 3
Fig. 3
Surgical excision of a second branchial cleft fistula. a - Orange peel incision encircling the fistulous opening. b - Step-by-step dissection of the fistula, which ascends towards the tonsillar region. c - Cervical fistula after resection.
Fig. 4
Fig. 4
Surgical excision of a second branchial cleft cyst en bloc with its tract. a - Step-by-step dissection of the cyst. b - Step-by-step dissection of the cyst after identification of its tract, which ascends towards the tonsillar region (white arrow). c - Surgical specimen.
See this image and copyright information in PMC

References

    1. Goff C.J., Allred C., Glade R.S. Current management of congenital branchial cleft cysts, sinuses, and fistulae. Curr. Opin. Otolaryngol. Head Neck Surg. déc 2012;20(6):533–539. - PubMed
    1. Li W., Xu H., Zhao L., Li X. Branchial anomalies in children: a report of 105 surgical cases. Int. J. Pediatr. Otorhinolaryngol. janv 2018;104:14–18. - PubMed
    1. Paul I, Mohiyuddin SMA, A S, Mohammadi K, Babu P. The outcome of treatment in second branchial cleft anomalies: a case series. Cureus. 15(6):e40164. - PMC - PubMed
    1. Spinelli C., Rossi L., Strambi S., Piscioneri J., Natale G., Bertocchini A., et al. Branchial cleft and pouch anomalies in childhood: a report of 50 surgical cases. J. Endocrinol. Investig. mai 2016;39(5):529–535. - PubMed
    1. Mathew G., Sohrabi C., Franchi T., Nicola M., Kerwan A., Agha R., et al. Preferred reporting of case series in surgery (PROCESS) 2023 guidelines. Int. J. Surg. Lond. Engl. 21 nov 2023;109(12):3760–3769. - PMC - PubMed