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First branchial cleft cyst excision with electrophysiological facial nerve localization
1Department of Otorhinolaryngology-Bronchoesophagology, Temple University School of Medicine and Temple University Children's Medical Center, Philadelphia, PA 19140, USA.
Insights
Electrophysiological facial nerve localization offers a safe and effective alternative for excising select first branchial cleft cysts, improving cosmetic outcomes without compromising nerve function.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Neurosurgery
Background:
- First branchial cleft cysts are congenital anomalies that can present with varied clinical manifestations.
- Surgical excision is the primary treatment, typically involving anatomical identification of the facial nerve.
Purpose of the Study:
- To evaluate the safety and efficacy of using electrophysiological nerve localization instead of anatomical identification for first branchial cleft cyst excision.
- To assess outcomes including lesion removal, facial nerve integrity, recurrence, and cosmetic results.
Main Methods:
- Retrospective review of 11 pediatric patients undergoing first branchial cleft cyst excision over 9 years.
- A consistent surgical technique utilizing electrophysiological localization of the facial nerve was employed.
- Surgical approach was smaller than typically advocated.
Main Results:
- Ten of 11 cysts were successfully removed without anatomical facial nerve localization.
- No instances of facial nerve injury, cyst recurrence, or Fry syndrome were observed.
- Follow-up ranged from 6 months to 7 years, with superior cosmetic outcomes reported.
Conclusions:
- Electrophysiological localization is a viable alternative to anatomical identification for specific first branchial cleft cysts.
- This technique is suitable for cysts superior to the stylomastoid foramen that are uninfected and unoperated.
- This approach enhances safety and cosmesis in pediatric first branchial cleft cyst surgery.
Objective:
To assess the safety and efficacy of surgical excision of selected first branchial cleft cysts using electrophysiological rather than anatomical location of the facial nerve.
Design:
Retrospective review of consecutive surgical procedures by a single surgeon, using a consistent technique during a 9-year period.
Setting:
Tertiary pediatric medical center.
Patients:
Eleven children with first branchial cleft cysts.
Interventions:
Selected first branchial cleft cysts were removed using a smaller surgical approach than that generally advocated. The facial nerve was localized using electrophysiological means rather than superficial parotidectomy and identification of the nerve trunk and branches.
Main Outcome Measures:
Successful removal of the lesion, avoidance of facial nerve injury, incidence of Fry syndrome, and cosmesis.
Results:
Eleven patients underwent surgical excision of first branchial cleft cysts during a 9-year period. Ten lesions were removed without the need for anatomical localization of the facial nerve trunk. There was no facial weakness, recurrence of the lesions, or Fry syndrome during a follow-up of 6 months to 7 years. Cosmesis was superior.
Conclusion:
Electrophysiological location of the facial nerve may, in the appropriate setting, replace anatomical localization for first branchial cleft cysts that are (1) superior to the stylomastoid foramen and (2) not previously infected or surgically violated.
