Branchial cleft anomaly: Difference between revisions
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==Background== | ==Background== | ||
During | *During 4th week of embryonic development, five branchial arches grow into distinct parts of head and neck | ||
*All consist of arteries, nerves, muscle, skeletal tissue | |||
*If arches fail to fuse--> soft tissue anomaly on lateral neck may form, called branchial cleft anomaly | |||
*Anomalies include cysts (most common), fistulas, sinus tracts | |||
*2nd branchial cleft anomalies most common | |||
==Clinical Features== | ==Clinical Features== | ||
*Lateral neck soft tissue anatomy | |||
*Typically asymptomatic unless superinfected causing cellulitis or abscess formation | *Typically asymptomatic unless superinfected causing cellulitis or abscess formation | ||
*First branchial cleft cyst | *First branchial cleft cyst | ||
**Lump in parotid/auricular region | **Lump in parotid/auricular region | ||
**Facial nerve palsy | **[[Cranial nerve palsies|Facial nerve palsy]] | ||
**May drain through neck and external auditory canal | **May drain through neck and external auditory canal | ||
*Second branchial cleft cyst | *Second branchial cleft cyst | ||
**Most common | **Most common | ||
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**Swelling below angle of mandible and anterior to sternocleidomastoid | **Swelling below angle of mandible and anterior to sternocleidomastoid | ||
**Sinus tracts travel into the deep neck structures and drain into tonsillar fossa | **Sinus tracts travel into the deep neck structures and drain into tonsillar fossa | ||
**Fistulae cause | **Fistulae cause mucus drainage from cutaneous opening at lateral neck | ||
**Very rarely become squamous cell carcinoma | **Very rarely become [[squamous cell carcinoma]] | ||
*Third and fourth branchial cleft cyst | *Third and fourth branchial cleft cyst | ||
**Difficult to differentiate between the two | **Difficult to differentiate between the two | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
====Acute==== | ====Acute==== | ||
*Reactive lymphadenopathy- most common | *Reactive [[lymphadenopathy]]- most common | ||
**Viral URI | **Viral [[URI]] | ||
**[[EBV]] | **[[EBV]] | ||
**[[CMV]] | **[[CMV]] | ||
**Strep/staph | **[[Strep]]/[[staph]] | ||
**[[HIV]] | **[[HIV]] | ||
**[[Toxoplasmosis]] | **[[Toxoplasmosis]] | ||
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====Subacute (weeks to months)==== | ====Subacute (weeks to months)==== | ||
*Cancer | *Cancer | ||
**HPV-related squamous cell carcinoma | **HPV-related [[squamous cell carcinoma]] | ||
**Upper aerodigestive tract squamous cell carcinoma | **Upper aerodigestive tract [[squamous cell carcinoma]] | ||
**Metastatic disease | **Metastatic disease | ||
**[[Lymphoma]] | **[[Lymphoma]] | ||
**Parotid tumors | **Parotid tumors | ||
*Systemic diseases | *Systemic diseases | ||
**Amyloidosis | **[[Amyloidosis]] | ||
**[[Sarcoidosis]] | **[[Sarcoidosis]] | ||
**Sjögren syndrome | **[[Sjögren syndrome]] | ||
====Chronic==== | ====Chronic==== | ||
*Thyroid nodules or cancer | *[[Thyroid]] nodules or cancer | ||
*Goiters | *Goiters | ||
**[[Graves' disease]] | **[[Graves' disease]] | ||
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==Management== | ==Management== | ||
*Surgical excision is definitive treatment (high risk of recurrence if not completely excised) | *Surgical excision is definitive treatment (high risk of recurrence if not completely excised) | ||
*Antibiotics if superinfection present | *[[Antibiotics]] if superinfection present | ||
==Disposition== | ==Disposition== | ||
Revision as of 18:19, 14 September 2019
Background
- During 4th week of embryonic development, five branchial arches grow into distinct parts of head and neck
- All consist of arteries, nerves, muscle, skeletal tissue
- If arches fail to fuse--> soft tissue anomaly on lateral neck may form, called branchial cleft anomaly
- Anomalies include cysts (most common), fistulas, sinus tracts
- 2nd branchial cleft anomalies most common
Clinical Features
- Lateral neck soft tissue anatomy
- Typically asymptomatic unless superinfected causing cellulitis or abscess formation
- First branchial cleft cyst
- Lump in parotid/auricular region
- Facial nerve palsy
- May drain through neck and external auditory canal
- Second branchial cleft cyst
- Most common
- Present in late childhood or early adulthood
- Swelling below angle of mandible and anterior to sternocleidomastoid
- Sinus tracts travel into the deep neck structures and drain into tonsillar fossa
- Fistulae cause mucus drainage from cutaneous opening at lateral neck
- Very rarely become squamous cell carcinoma
- Third and fourth branchial cleft cyst
- Difficult to differentiate between the two
- Located lower in neck, anterior or posterior to sternocleidomastoid
- Preference for left side
Differential Diagnosis
Acute
- Reactive lymphadenopathy- most common
- Viral URI
- EBV
- CMV
- Strep/staph
- HIV
- Toxoplasmosis
- Bartonella henselae- kitten or flea exposure
- Tuberculous lymphadenitis (scrofula)
- Descending infections from oral cavity
- Sialoadenitis (can also be chronic)
- Trauma-related
- Hematoma
- Pseudoaneurysm or AV fistula
Subacute (weeks to months)
- Cancer
- HPV-related squamous cell carcinoma
- Upper aerodigestive tract squamous cell carcinoma
- Metastatic disease
- Lymphoma
- Parotid tumors
- Systemic diseases
Chronic
- Thyroid nodules or cancer
- Goiters
- Graves' disease
- Hashimoto thyroiditis
- Iodine deficiency
- Lithium use
- Toxic multinodular
- Congenital cysts
- Thyroglossal duct cyst- 2nd most common benign neck mass
- Dermoid cyst
- Carotid body tumor
- Glomus jugulare or vagale tumor
- Laryngocele
- Lipoma/liposarcoma
- Parathyroid cysts or cancer
Evaluation
- Ultrasound
- CT
- MRI
Management
- Surgical excision is definitive treatment (high risk of recurrence if not completely excised)
- Antibiotics if superinfection present
Disposition
- Discharge with outpatient surgical referral (if no systemic signs of infection present)
- Admit for sepsis