Three cases of first branchial cleft anomalies

Abstract

First branchial cleft anomalies present with lesions from the ear canal to the lower jaw. We report 3 cases of first branchial cleft anomalies requiring surgical treatment. [Case 1] In a 14-month-old girl, an otolaryngologist detected a 6.6 mm mass in the right external auditory canal. Under the diagnosis of auditory canal cholesteatoma, surgery (TEES) was performed. After 10 months, swelling appeared in the right cervical region. The swelling progressed to form an abscess within a month, and was treated by incision of the neck. [Case 2] A 22-month-old girl had a 4 cm mass on the lower pinna and a small horizontal fistula leading toward the neck was detected by imaging. The mass was resected and incision of the neck was performed to treat the fistula. [Case 3] In a 115-month-old girl, an otolaryngologist identified a mass containing serous fluid in the right external auditory canal. In addition, a vertical fistulous tract was observed by MRI. Surgery to remove these lesions was performed via a retroauricular incision.

When first branchial cleft anomalies are suspected, such as in a patient with who has a cystic lesion, MRI should be considered for confirmation, even if the preoperative diagnosis is cholesteatoma. While surgical treatment is required, the fistulas are located close to the facial nerve and symptoms develop during childhood in many cases. We should perform surgery with particular care after full evaluation of the positional relationship between the lesion and the facial nerve with reference to the Belenky classification.