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Right-Sided Type IV Branchial Cleft Anomaly in a Seven-Year-Old Boy: A Case Report
Janvi J Shukla1, Sara Morgan1, David Wassef1
1Otolaryngology - Head and Neck Surgery, Rutgers University New Jersey Medical School, Newark, USA.
Insights
Type IV branchial cleft anomalies are rare congenital conditions. A novel ablation technique successfully treated a rare right-sided type IV branchial cleft cyst in a child, avoiding surgery.
Area of Science:
- Congenital anomalies
- Pediatric surgery
- Otolaryngology
Background:
- Type IV branchial cleft anomalies are the rarest congenital malformations of the branchial apparatus.
- These anomalies typically manifest in childhood with recurrent neck abscesses and can involve the sternocleidomastoid muscle and pyriform sinus.
Observation:
- A seven-year-old boy presented with a rare right-sided type IV branchial cleft cyst.
- Diagnostic imaging included ultrasound, CT, MRI, sinogram, and direct laryngoscopy.
Findings:
- The case highlights a successful primary treatment of a right-sided type IV branchial cleft cyst using Bugbee cauterization and drainage.
- This minimally invasive approach avoided the need for surgical excision or thyroidectomy.
Implications:
- Ablation techniques may offer a viable alternative to surgery for specific branchial cleft anomalies.
- This approach could potentially reduce morbidity and improve patient outcomes in pediatric cases.
Abstract:
Type IV branchial cleft anomalies, which can present as a cyst, sinus, or fistula, are the rarest type of branchial cleft anomalies. Although they can present at any age, they typically present during childhood with a history of frequent neck abscesses. Type IV branchial cleft anomalies usually occur on the left side near the medial lower border of the sternocleidomastoid (SCM) muscle and can extend to the pyriform sinus in the larynx. They can also present with thyroid involvement. Imaging with ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), sinogram, and direct laryngoscopy (DL) can aid in diagnosis. Sinus tracts, while not always present, may develop as a complication. Treatment is with surgical excision of the tract and debridement of the abscess in the setting of acute infection. Here, we present a rare case of right-sided type IV branchial cleft cyst in a seven-year-old boy who was treated primarily with ablation using Bugbee cauterization and drainage, avoiding the need for any further surgical intervention, including further drainage or thyroidectomy.
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