Clinical Analysis Of Branchial Anomalies

Object: To find the clinical features of branchial anomalies and to explorethe better treatment protocol of patients by summary and analysis of63caseswith branchial anomalies.Method: We collected the cases diagnosed with branchial anomaliesbetween2005and2012at the first hospital of Jilin university. The anomalieswere divided into three categories according to their locations, respectively firstbranchial anomalies, second branchial anomalies, third and fourth branchialanomalies. Every patient’s gender, age, duration of disease, clinical pre-sentations, abscess history, past surgery history, imaging test, operationmethods, recurrence rate were recorded. Then it was analysed what were theclinical features, advantages of different imaging test, differential diagnosis,choice of operation methods, cause of recurrence and characters of branchialcarcinoma.Results：There were fifteen cases with first branchial anomalies，thirty-six cases with second branchial anomalies, twelve cases with third and fourthbranchial anomalies. The male to female ratio was32:31. The mean age andduration was twenty-two years old and thirty-three months. Forty-four patientshad left lesions and twelve patients had right lesions. Bilateral and middlelesions are two and two respectively. Forty-nine anomalies were confirmedwith branchial cysts, and number of branchial sinus or fistulae is fourteen.Forty-three patients underwent ultrasound before surgery and nine patients hadCT scan. Of first branchial anomalies, number of patients underwentcystectomy/fistulectomy or drainage was thirteen and one respectively.Onecases chose conservation therapy. Of second branchial anomalies, number ofpatients underwent cystectomy/fistulectomy, drainage or tonsillectomy wastwenty-five, nine and one respectively. Of third and fourth branchial anomalies,number of patients underwent cystectomy/fistulectomy, drainage or partial thyroidectomy was eight, three and one respectively. Complications of surgeryincluded post-surgery infection and transient vocal cord paralysis. Eightpatients had drainage history before surgery. Three cases recurred after surgery.There was a case presenting with right neck mass who underwent right neckdissection. The final pathology was branchial carcinoma with local lymphnodes metastasis (2/8).Conclusion: Branchial anomalies has the highest mortality in children,declining with age. The mean duration is long and varies among different typesof anomalies. The sequence of mortality is2nd,1stand3rdanomalies, but1stand3rdhas a higher incidence than theory. There are more anomalies lies left sidethan right side. The pre-operative infection history, the method to deal with thebranches and inner open of anomalies, complicated anatomy features ofanomalies, different abilities of doctors and patients’ factors may be attributedto the high recurrent rate.