Children’s Congenital First Branchial Cleft Clinical Analysis

Background: First branchial cleft is a congenital disease related to head and face, and usually occurs in childhood. The main clinical manifestations were purulent infections around the air. It is not rare in clinical practice. However, there is no criterion in such aspects as diagnosis and treatment in many hospitals, and the postoperative recurrence rate is high. Fistula angiography, ultrasound and CT, methylene blue staining examination could help diagnose the disease. At present, the main mode of treatment is to remove the lesion mainly by surgery. The facial nerve and its branches are at risk during the operation due to the special location of the lesion. Dissection of facial nerve and its branches, and partial resection of the ipsilateral parotid gland are usually needed in order to remove the fistula and cyst completely. With the further understanding and assessment of the disease, and using examinations such as fistulography, CT examination, treatment can achieve good effect and recurrence rate is also significantly decreased.objective:Retrospective analysis was conducted in 31 patients with definite diagnosis of congenital first branchial cleft malformation. Further explore clinical characters, the diagnosis and treatment of the common problems in the process in order to choose the best treatment.Methods: The information of first gill cleft case was collected from 2006 to 2016 in the children’s Hospital of Chongqing Medical University. The disease could be divided into branchial cleft fistula, gill cleft sinus, branchial cleft cyst according to the nature of the lesions and whether the fistula was connected with skin or cavity or not. Calculated the fistula and cyst lesion location, fistula and cyst infection history, concomitant diseases, the choice of operation scheme, preoperative and postoperative findings and complications, conditions of fistula and cyst and their relationship with facial nerve during operation, gender, age, and following-up result. And assess the clinical characteristics of the disease, the advantages and disadvantages of the commonly used examinations, operation plan, additional tests, causes of postoperative recurrence.result:In this group, 19 cases were male and 12 were female. 12 case in the left side. 19 case in the right side. No case in the both sides. All cases were examined by ultrasonography before operation. 13 cases of preoperative CT examination of head face. 1 case MRI examination.4 cases of fistula angiography. 18 cases ear endoscopy. Cyst of 7 cases.Left 3 cases, right side 4 cases, Are located in the back of the ear. 11 cases of fistula, 13 cases of sinus; The 13 cases is in the back of the ear, 5 cases were located in the earlobe, 4 cases were located in the mandibular angle, 2 cases were located in the ear cavity; 13 cases of fistula in the end is located in external auditory meatus. Located in the anterior part of the papilla in 2 cases, 1 cases of deep surface of the papilla, 2 cases were located on the surface of parotid gland, 1 cases of facial nerve dry surface, Mandibular angle in 1 cases, 4 cases of auricular cartilage. 4 cases had close relationship with facial nerve anatomy, Need to separate facial nerve during operation. 5 cases with dilated cystic fistula and terminal branches, Only 2 cases of cystic enlargement at the end.3 cases with preauricular fistula, 2 cases with atresia of external auditory canal and abnormal hearing(both in the lesion side). Operation age is 1 years old in January ~15 years old, The average age is about 5.8 years old; 6 cases in 1~3 years old, 15 cases in 3~6 years old, 3 cases at the age of 6 ~9 years old, 7 cases at the age of 9 ~15 years old. In 31 cases, 30 cases were infected before operation, 1 case were not infected, 2 cases were operated under microscope. Pathological examination results are consistent with the diagnosis of gill cleft; 26 cases are covered with squamous epithelium, 4 cases contain skin appendages, 1 cases of fistula with columnar epithelium, Does not contain cartilage like tissue, According to work classification are class I [1]. Facial nerve injury in 1 cases of facial paralysis(grade 3, after conservative treatment, the basic return to normal). 27 cases were followed up, of which 4 cases recurred. Operation record of recurrence: 1 cases of fistula and end branches of facial nerve related cases, Only 1 cases of fistula end branch, 1 cases of cyst with facial nerve dissection, 1 cases of simple cyst, There was no recurrence after reoperation.Conclusion: First gill cleft malformation is a congenital disease. 1)The rate of diagnosis of the disease is not low, this group of 31 cases were in preoperative diagnosis; 2) This group of cases were located above the hyoid level were mainly located in the ear week; 3) Often in childhood surgery treatment after the onset of infection. 3~6 years of age for the onset of the peak, with age, the incidence decreased significantly; 4) This group of cases showed that the First branchial is often associated with congenital malformations of local tissues and organs, such as preauricular fistula, accessory ear, middle ear and external auditory canal dysplasia; 5) The disease is diagnosed with a careful examination of the foundation, Still combined with relevant imaging; 6) The first branchial fistula were malformation and morphological diversity. According to work classification to class I [1]; 7) The main reason for recurrence with preoperative infection, Fistula preoperative evaluation and the Treatment of branch, preoperative fistula surgery branch of the treatment, and Fistula(cysts) nerve(facial nerve) is closely related to anatomy.