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First Brachial Cleft Anomalies in Children: An Innovative Surgical Technique Preventing External Auditory Canal
Michal Kotowski1, Jaroslaw Szydlowski1
1Department of Pediatric Otolaryngology, Poznan University of Medical Sciences, 60-572 Poznan, Poland.
Insights
This study introduces a novel surgical method for first branchial cleft anomalies (FBCAs) in children. The technique uses part of the anomaly for reconstruction, successfully preventing external auditory canal stenosis without recurrence.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Congenital Malformations
Background:
- First branchial cleft anomalies (FBCAs) are rare congenital malformations requiring complete surgical excision.
- Post-surgical external auditory canal (EAC) stenosis can occur as a complication of FBCA treatment.
Purpose of the Study:
- To present an innovative surgical technique for FBCA reconstruction using a portion of the anomaly.
- To evaluate the safety and efficacy of this technique in preventing EAC stenosis and recurrence.
Main Methods:
- Retrospective analysis of 28 pediatric patients with FBCAs treated between 2014 and 2021.
- Classification of anomalies based on Work's system (Type I and Type II FBCAs).
- Application of a novel subtotal resection and simultaneous reconstruction technique in 14 patients.
Main Results:
- The innovative technique was performed on 14 children (1 Type I, 13 Type II FBCA).
- All cases demonstrated uncomplicated wound healing.
- No instances of recurrence were observed post-surgery.
Conclusions:
- The described subtotal resection with simultaneous reconstruction is a safe and effective method for treating FBCAs.
- This technique successfully prevents postoperative EAC stenosis.
- Utilizing a portion of the anomaly wall for reconstruction does not increase the risk of recurrence.
Abstract:
First branchial cleft anomalies (FBCAs) are rare congenital malformations that require complete surgical removal. A stenosis of the external auditory canal (EAC) may be the consequence of the disease and its treatment. The aim of this study is to present the details and results of an innovative surgical technique using part of the abnormality for reconstruction purposes. This study covered 28 surgically treated children with FCBA between 2014 and 2021. The analysis included the clinical manifestation form of the abnormality, presence of the EAC deformity, histopathological results, complications, and distant results. On the basis of Work's classification system, 15 pediatric patients with type II FBCA and 13 children with type I FBCA were included in the further study. One child with type II FBCA and two with type I FBCA had a normal EAC. The preoperative appearance of the EAC was classified into three main types, each potentially accompanied by a skin ostium of the sinus/fistula in the EAC. Reconstruction with our technique was performed in 14 children (1 with type I FBCA and 13 with type II FBCA). Wound healing was uncomplicated in all cases. No recurrences were observed. This innovative surgical technique of the subtotal resection of FBCAs with simultaneous reconstruction is safe and prevents postoperative EAC stenosis. Despite the deliberate use of part of the abnormality wall for reconstructive purposes, it remained free of recurrences.
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