Clinical Characteristic Analysis And Therapeutic Evaluation Of Second Branchial Cleft Anomalies

backgroundThe second branchial cleft anomalies are a spectrum of congenital defects,which mainly manifests as recurrent mass,infection or cutaneous fistula in the anterior-lateral surface of the neck along with the anterior border of the sternocleidomastoid muscle,caused by incomplete closure of branchial clefts or pouches in the early embryonic life.The process of diagnosis and treatment for the second branchial cleft anomalies has not been standardized.objectiveThe purpose of this article is to present clinical features,diagnostic methods and surgical treatment of second branchial anomalies on the basis of a series of 168 eligible cases.And the standardization of diagnosis and treatment process was summarized.MethodA retrospective analysis on the database of the First Affiliated Hospital of Zhengzhou University has been performed for the second branchial cleft anomalies from February 2012 to December 2017.The clinical data regarding age,sex,clinical presentation,localization,imaging,surgical treatment and postoperative complications,were analyzed.Result1.Among 168 cases(91 males and 77 females),160 cases were found in unilateral side and 8 cases were bilateral.And 95 cases presented as cysts,66 cases as sinuses and 7 cases as fistulas.The average age of cysts was 21.91±13.168 years old,while the mean age of sinuses and fistulas was 3.03 ± 7.275 years old.The second branchial cleft anomalies mainly presented as cervical skin fistula(42.26%),painless mass(39.29%)and inflammatory mass(16.67%).Ultrasonography was performed in118 cases,CT in 94 cases,MRI in 35 cases and fistulography in 4 cases.Following-up from 12 to 82 months after operation,13 cases were found with several complications and 10 cases relapsed.2.There was no significant difference on intraoperative blood loss,24-hour postoperative drainage,postoperative hospital stay,complications and recurrence rate between the tonsillectomy group and the group of tonsil preservation(P > 0.05),but the operation time was significantly different between the two groups(P < 0.05),and the tonsillectomy group has a longer operative time.3.The history of cervical abscess incision and drainage or cystectomy was a significant predictor for the recurrence of second branchial cleft anomalies(P < 0.05;odds ratio=5.529;95%CI of odds ratio=1.417 to 21.577).conclusion1.The second branchial cleft anomalies have no sexual dominant and usually occur unilaterally.Second branchial cleft sinuses and fistulas usually occur in children,while second branchial cleft cysts often occur in youth.Second branchial cleft anomalies mainly manifest as cervical skin fistula,painless neck mass andinflammatory neck mass.2.Fistulography should be performed in second branchial cleft sinus or fistula during CT and MRI examination.3.Simultaneous tonsillectomy is not necessary for second branchial cleft sinuses and fistulas.4.Patients with the history of cervical abscess incision and drainage or cystectomy has a higher relapse rate.