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Second branchial cleft anomalies: Surgical management and long-term outcomes in a pediatric case series
Jihène Houas1, Monia Ghammam1, Taissir Ben Arfi1
1Department of Otorhinolaryngology-Head and Neck Surgery, Farhat Hached University Hospital, Sousse, Tunisia; Sousse Medical School, University of Sousse, Sousse, Tunisia.
Insights
Early diagnosis and surgical excision of second branchial cleft anomalies in children are vital. High fistula ligation effectively prevents recurrence, avoiding tonsillectomy and ensuring positive long-term outcomes.
Area of Science:
- Pediatric Surgery
- Congenital Malformations
- Otolaryngology
Background:
- Second branchial cleft anomalies are common congenital malformations in children, presenting as cysts, fistulas, or cervical masses.
- Early detection and management are crucial to prevent complications like superinfection.
Purpose of the Study:
- To evaluate the clinical presentation, surgical treatment, and long-term outcomes of pediatric patients with second branchial cleft anomalies.
Main Methods:
- Retrospective review of 16 children treated for lateral cervical cysts/fistulas (2005-2020).
- Diagnostic tools included ultrasound and CT.
- Surgical excision of the cyst and fistula was performed in all cases.
Main Results:
- Ten patients had second branchial cleft anomalies (mean age 8 years, 80% female).
- Common symptoms were cervical swelling, fistulas, and superinfection.
- High ligation of the fistula prevented recurrence in all cases, with no need for tonsillectomy.
Conclusions:
- Second branchial cleft anomalies necessitate early diagnosis and surgical excision to prevent complications.
- High fistula ligation is an effective treatment to prevent recurrence.
- Complete excision without tonsillectomy is a recommended surgical approach.
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.
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