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First branchial cleft anomaly: a report of case
T Takimoto1, J Iwawaki, S Ishikawa
1Department of Otolaryngology, School of Medicine, Kanazawa University, Japan.
Auris, Nasus, Larynx
|January 1, 1989
Summary
A rare first branchial cleft anomaly presented as a fistulous tract near the mandible in a 21-year-old female. Surgical removal preserved the facial nerve, with histopathology confirming its epithelial and cartilaginous nature.
Area of Science:
- Otolaryngology
- Head and Neck Surgery
- Developmental Abnormalities
Background:
- Branchial cleft anomalies are congenital malformations arising from persistent embryonic pharyngeal arches.
- First branchial cleft anomalies are less common than second or third, often presenting with recurrent infections or drainage near the ear or neck.
- Accurate diagnosis and surgical management are crucial to prevent complications and ensure patient well-being.
Observation:
- A 21-year-old female presented with a rare first branchial cleft anomaly.
- A fistulous tract was identified extending from the mandibular angle, anterior to the sternocleidomastoid muscle, superior to the facial nerve, and opening into the external auditory canal.
- The anomaly involved complex anatomical relationships with surrounding structures, including the facial nerve.
Findings:
- Complete surgical excision of the fistulous tract was successfully performed.
- The facial nerve was identified and preserved during the surgical procedure.
- Histopathologic examination confirmed the tract was lined by keratinizing squamous cell epithelium and contained adnexal structures and cartilage, consistent with a first branchial cleft remnant.
Implications:
- This case highlights the importance of considering rare first branchial cleft anomalies in the differential diagnosis of neck masses or ear drainage.
- Successful surgical management with preservation of the facial nerve is achievable, emphasizing meticulous surgical technique.
- Understanding the embryological basis and anatomical course of these anomalies is vital for effective treatment and improved patient outcomes in head and neck surgery.