Branchial arch anomalies can arise from the four first branchial arches, but the most encountered cases are from the second one. Second branchial arch cysts and abscesses occur mainly in older children or young adults...Branchial arch anomalies can arise from the four first branchial arches, but the most encountered cases are from the second one. Second branchial arch cysts and abscesses occur mainly in older children or young adults while fistulae are discovered in young children. We report a case of complete second branchial arch fistula of Bailey III type with adult complaints of painful swelling and local reddishness followed by spontaneous discharge and disappearance of complaints. Diagnosis was based on ultrasound and confirmed by CT scan, with the classic “beak sign” visible on both exams. Three cases were encountered in the family, with no otologic or kidney symptoms, which is quite different from the classical branchiootorenal syndrome which associates severe inner ear and kidney congenital anomalies.展开更多
BACKGROUND Treatment of fistulas arising from the third branchial cleft includes endoscopic cauterization or open cervical fistulectomy.Both approaches are associated with recurrence rates of 14%-18%,and possibly grea...BACKGROUND Treatment of fistulas arising from the third branchial cleft includes endoscopic cauterization or open cervical fistulectomy.Both approaches are associated with recurrence rates of 14%-18%,and possibly greater rates when the fistula has been treated operatively beforehand.Treatment of fistulas arising from the third branchial cleft is associated with an inordinate recurrence rate.Recurrence may be multifactorial and related to incomplete resection of all of the anatomical elements of the fistula.AIM To present a new approach that involves complete resection of the recurrent fistula by a combined therapeutic approach.METHODS Here,12 adult patients diagnosed with recurrent third branchial cleft fistulas underwent a combined therapy assisted by flexible fiber-optic pharyngoscopy to identify and resect the entry site of the fistula into the pyriform sinus.The fistulous opening into the pyriform sinus was identified by flexible fiber-optic pharyngoscopy.The application of intubation with a guidewire by pharyngoscopy,in addition to the removal of the partial excision of the thyroid cartilage,allowed complete resection of the opening and all parts of the fistula tract.RESULTS All of the internal openings of the fistulas in the pharynx were found and easily identified by flexible fiber-optic pharyngoscopy.All of the 12 patients underwent complete resection of the recurrent fistula by the combined therapeutic approach.There were no postoperative complications such as parapharyngeal abscess or wound infection,injury or dysfunction of the recurrent laryngeal or superior laryngeal nerves.The pharyngeal edema had degraded,and the pharyngeal wound healed postoperatively within 1 wk.Laryngeal endoscopy and voice analysis were performed on the 14th d post-operatively.Vocal cord movements did not change.The characters of voice for jitter,shimmer,and normalized noise energy were all within normal limits.In addition,no recurrences were observed during the 13-60 mo follow-up period.CONCLUSION It can be concluded that the proposed combined therapy is associated with excellent results,minimal morbidity,and no recurrence.展开更多
Objective: Report a rare case of a thyroid papillary carcinoma situated within a branchial cleft cyst. Case presentation: A 40-year-old male was referred to our department for a lateral neck mass assessment. Physical ...Objective: Report a rare case of a thyroid papillary carcinoma situated within a branchial cleft cyst. Case presentation: A 40-year-old male was referred to our department for a lateral neck mass assessment. Physical examination revealed a solitary palpable, painless, moveable neck mass. Assessment included complete nasal, pharynx and larynx endoscopy, neck computed tomography, and fine needle aspiration biopsy. Treatment was surgical excision of the neck mass. Histopathology confirmed a branchial cleft cyst with papillary thyroid carcinoma growth at a site. A neck and thyroid ultrasound showed presence of thyroid gland nodules (one of which with micro calcifications). Thyroid fine needle aspiration biopsy performed, was high suspicious for malignancy (BETHESDA V). Patient underwent total thyroidectomy and histopathology revealed papillary thyroid carcinoma. Conclusion: Although rarely, it is possible to face an unexpected malignancy within a clinically benign neck lesion. A thorough diagnostic work-up enables early identification of aforementioned potential malignancy. A diagnostic dilemma that arises in such cases is between primary or metastatic disease and a thyroid carcinoma arising from ectopic thyroid tissue.展开更多
Amygdaloid cysts are rare cystic benign tumors due to congenital malformations resulting from an anomaly of embryonic development of the upper laterocervical region, originating from the second branchial cleft. They r...Amygdaloid cysts are rare cystic benign tumors due to congenital malformations resulting from an anomaly of embryonic development of the upper laterocervical region, originating from the second branchial cleft. They represent approximately 2% of all laterocervical tumors and 6% to 85% of anomalies of the second branchial cleft. This anomaly of the second branchial cleft is a frequent reason for consultation in the pediatric population but is relatively rare in adults. We report the cases of two patients aged 23 and 34 years with no particular pathological history. They were presenting a laterocervical swelling, one right and the other left, painless, evolving for two years for the first and for 10 years for the second, gradually increasing in volume without any other associated signs the diagnosis of which after radiological exploration (ultrasound and CT scan) was that of an amygdaloid cyst. A cervicotomy with anatomopathological examination of the surgical specimen confirmed the diagnosis of the amygdaloid cyst. The objective is to analyze the anatomo-clinical and therapeutic particularities of this pathology and to compare it with data from the literature.展开更多
Branchiogenic carcinoma is extremely rare. The majority of branchiogenic carcinomas are cystic metastases originating in the tonsils, and not true carcinomas arising in a branchial cleft cyst. Isolated cystic neck les...Branchiogenic carcinoma is extremely rare. The majority of branchiogenic carcinomas are cystic metastases originating in the tonsils, and not true carcinomas arising in a branchial cleft cyst. Isolated cystic neck lesions necessitate a thorough search for a primary tumor, as with other occult primaries presenting with cervical metastases. As the existence of primary branchiogenic carcinoma is controversial, Martin and colleagues and then Khafif and coworkers established a series of widely accepted criteria to recognize this type of carcinoma. We report a case of a large cervical mass, consistent with a branchiogenic carcinoma of the second branchial arch. The patient underwent excision of the neck mass through a radical neck dissection. The cyst wall was found to have squamous cell carcinoma arising from the benign epithelium. Follow-up at 7 years revealed no evidence of recurrence. All diagnostic criteria for a true branchiogenic carcinoma were met in this case. The absence of adjuvant irradiation is a further confirmation that the mass is not a cystic node metastasis but a carcinoma arised from within a branchial cleft cyst.展开更多
文摘Branchial arch anomalies can arise from the four first branchial arches, but the most encountered cases are from the second one. Second branchial arch cysts and abscesses occur mainly in older children or young adults while fistulae are discovered in young children. We report a case of complete second branchial arch fistula of Bailey III type with adult complaints of painful swelling and local reddishness followed by spontaneous discharge and disappearance of complaints. Diagnosis was based on ultrasound and confirmed by CT scan, with the classic “beak sign” visible on both exams. Three cases were encountered in the family, with no otologic or kidney symptoms, which is quite different from the classical branchiootorenal syndrome which associates severe inner ear and kidney congenital anomalies.
文摘BACKGROUND Treatment of fistulas arising from the third branchial cleft includes endoscopic cauterization or open cervical fistulectomy.Both approaches are associated with recurrence rates of 14%-18%,and possibly greater rates when the fistula has been treated operatively beforehand.Treatment of fistulas arising from the third branchial cleft is associated with an inordinate recurrence rate.Recurrence may be multifactorial and related to incomplete resection of all of the anatomical elements of the fistula.AIM To present a new approach that involves complete resection of the recurrent fistula by a combined therapeutic approach.METHODS Here,12 adult patients diagnosed with recurrent third branchial cleft fistulas underwent a combined therapy assisted by flexible fiber-optic pharyngoscopy to identify and resect the entry site of the fistula into the pyriform sinus.The fistulous opening into the pyriform sinus was identified by flexible fiber-optic pharyngoscopy.The application of intubation with a guidewire by pharyngoscopy,in addition to the removal of the partial excision of the thyroid cartilage,allowed complete resection of the opening and all parts of the fistula tract.RESULTS All of the internal openings of the fistulas in the pharynx were found and easily identified by flexible fiber-optic pharyngoscopy.All of the 12 patients underwent complete resection of the recurrent fistula by the combined therapeutic approach.There were no postoperative complications such as parapharyngeal abscess or wound infection,injury or dysfunction of the recurrent laryngeal or superior laryngeal nerves.The pharyngeal edema had degraded,and the pharyngeal wound healed postoperatively within 1 wk.Laryngeal endoscopy and voice analysis were performed on the 14th d post-operatively.Vocal cord movements did not change.The characters of voice for jitter,shimmer,and normalized noise energy were all within normal limits.In addition,no recurrences were observed during the 13-60 mo follow-up period.CONCLUSION It can be concluded that the proposed combined therapy is associated with excellent results,minimal morbidity,and no recurrence.
文摘Objective: Report a rare case of a thyroid papillary carcinoma situated within a branchial cleft cyst. Case presentation: A 40-year-old male was referred to our department for a lateral neck mass assessment. Physical examination revealed a solitary palpable, painless, moveable neck mass. Assessment included complete nasal, pharynx and larynx endoscopy, neck computed tomography, and fine needle aspiration biopsy. Treatment was surgical excision of the neck mass. Histopathology confirmed a branchial cleft cyst with papillary thyroid carcinoma growth at a site. A neck and thyroid ultrasound showed presence of thyroid gland nodules (one of which with micro calcifications). Thyroid fine needle aspiration biopsy performed, was high suspicious for malignancy (BETHESDA V). Patient underwent total thyroidectomy and histopathology revealed papillary thyroid carcinoma. Conclusion: Although rarely, it is possible to face an unexpected malignancy within a clinically benign neck lesion. A thorough diagnostic work-up enables early identification of aforementioned potential malignancy. A diagnostic dilemma that arises in such cases is between primary or metastatic disease and a thyroid carcinoma arising from ectopic thyroid tissue.
文摘Amygdaloid cysts are rare cystic benign tumors due to congenital malformations resulting from an anomaly of embryonic development of the upper laterocervical region, originating from the second branchial cleft. They represent approximately 2% of all laterocervical tumors and 6% to 85% of anomalies of the second branchial cleft. This anomaly of the second branchial cleft is a frequent reason for consultation in the pediatric population but is relatively rare in adults. We report the cases of two patients aged 23 and 34 years with no particular pathological history. They were presenting a laterocervical swelling, one right and the other left, painless, evolving for two years for the first and for 10 years for the second, gradually increasing in volume without any other associated signs the diagnosis of which after radiological exploration (ultrasound and CT scan) was that of an amygdaloid cyst. A cervicotomy with anatomopathological examination of the surgical specimen confirmed the diagnosis of the amygdaloid cyst. The objective is to analyze the anatomo-clinical and therapeutic particularities of this pathology and to compare it with data from the literature.
文摘Branchiogenic carcinoma is extremely rare. The majority of branchiogenic carcinomas are cystic metastases originating in the tonsils, and not true carcinomas arising in a branchial cleft cyst. Isolated cystic neck lesions necessitate a thorough search for a primary tumor, as with other occult primaries presenting with cervical metastases. As the existence of primary branchiogenic carcinoma is controversial, Martin and colleagues and then Khafif and coworkers established a series of widely accepted criteria to recognize this type of carcinoma. We report a case of a large cervical mass, consistent with a branchiogenic carcinoma of the second branchial arch. The patient underwent excision of the neck mass through a radical neck dissection. The cyst wall was found to have squamous cell carcinoma arising from the benign epithelium. Follow-up at 7 years revealed no evidence of recurrence. All diagnostic criteria for a true branchiogenic carcinoma were met in this case. The absence of adjuvant irradiation is a further confirmation that the mass is not a cystic node metastasis but a carcinoma arised from within a branchial cleft cyst.
