Branchial cleft anomalies: a five-year retrospective review

Branchial cleft cysts, sinuses and fistulas are among the most commonly encountered congenital anomalies in pediatric otolaryngic practice. They can present difficulties in differential diagnosis and surgical management. In order to study the clinical presentation and surgical management of branchial cleft anomalies, the operative records of the Children's Hospital of Philadelphia (CHOP) were reviewed for a five year period, January 1, 1982 through December 31, 1986. All patients with a pathologically-confirmed post-operative diagnosis of a branchial cleft anomaly were included in a retrospective chart review. Their case histories were studied to determine symptoms upon presentation, presence or absence of drainage, type of lesion, site of lesion, characteristics of the lesion, accuracy of pre-operative diagnosis, recurrence and complications. A total of 71 patients, 39 males and 32 females, underwent surgical excision of a branchial cleft cyst, sinus or fistula during the study period. There were 23 branchial cleft cysts, 50 sinuses and 3 fistulas. A correct pre-operative diagnosis was established in 60 (85%) of the patients, being highest for patients with branchial cleft fistulas. Incorrect pre-operative diagnoses included thyroglossal duct cyst, cervical lymphadenitis, dermoid, dermal inclusion cyst, lymphangioma and malignant neoplasm. The clinical presentation, pre-operative evaluation, pitfalls in diagnosis, surgical management and post-operative complications are discussed and strategies for the management of branchial cleft anomalies are presented.