Analysis of 15 cases of congenital first branchial cleft cysts and fistulas in children

doi:10.11958/20252736

Abstract

Abstract:

Objective To analyze the clinical characteristics, diagnosis and treatment of congenital first branchial cleft cysts and fistulas in children, and to improve the understanding of congenital first branchial cleft anomalies (FBCA). Methods A retrospective analysis was conducted on the data of 15 children with congenital first branchial cleft cysts and fistulas, including gender, age, medical history, side of lesion, physical examination results, preoperative imaging features, treatment methods, complication and prognosis. Results In the 15 children, there were 11 males and 4 females, aged from 1 to 12 years with a mean age of 5.4±3.1 years. The disease duration ranged from 0.5 to 72 months (with a median duration of 4 months). All cases had unilateral involvement, including 6 on the left side and 9 on the right side. There were 10 cases of cysts and 5 cases of fistulas. Two cases were of Work type Ⅱ and 13 cases were of Work type Ⅰ. The main symptoms of the children were postauricular masses or recurrent postauricular infections. All children underwent preoperative MRI examination, which showed that the lesions presented isointense or slightly long T₁ and long T₂ signals, and were closely related to the parotid gland or external auditory canal. All children treated with surgery and successfully completed. The intraoperative findings were consistent with the preoperative MRI indications. Postoperative pathology confirmed that all cases were consistent with the pathological manifestations of congenital branchial cleft cysts or fistulas. During the follow-up period of 5 to 20 months, no recurrence was observed in any of the 15 children. Conclusion Congenital first branchial cleft malformations in children are clinically rare. MRI has good diagnostic value and accurate surgical mapping for this condition. Complete surgical resection of the lesion can prevent recurrence and is currently the most effective treatment method.

Key words: congenital abnormalities, branchial region, fistula, cysts, facial nerve, child, surgery

CLC Number:

R726.35

Figures/Tables 4

References 19

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编号	年龄	疾病	病史	查体	MRI报告	B超报告
1	8岁	囊肿	发现右耳后肿物半月余	右下颌角后上与乳突前下间一质韧肿物	右腮腺后缘囊性病变边缘强化，上缘管状影像向外耳道延伸	右侧耳前囊性肿块（内部不透亮），与耳道关系密切。
2	8岁	囊肿	发现右耳后红肿化脓6年	右耳后见瘢痕，肿物约2 cm×2 cm	右耳后皮下至腮腺区稍长T₁、长T₂信号影	右侧耳后患处低回声肿块
3	5岁	囊肿	发现右耳后肿物2月余	右下颌角后上方耳后沟直径约1 cm肿物	右腮腺外缘及耳后区条片状等T₁、长T₂信号强化，边缘为著	右侧腮腺内及右耳后低回声区，考虑炎性
4	2岁	瘘管	左耳后红肿化脓7个月	左耳垂前上一小孔，左耳后近耳垂处瘢痕	左耳周皮下腮腺区片状不规则稍长T₁、长T₂信号影边缘强化	未查
5	2岁	囊肿	右耳后反复红肿化脓1年余	右耳后皮肤稍红肿，局部有瘢痕	右耳后局部皮下组织内不规则条状长T₂信号强化，其内侧缘向腮腺表面延伸	未查
6	6岁	囊肿	发现右耳后肿物伴反复感染2年	右耳后乳突偏下处有瘢痕	右耳部局部皮下软组织内不规则条片状长T₂信号边缘轻度强化，其内侧缘向腮腺表面延伸	未查
7	6岁	瘘管	出生后发现右耳前、耳垂各一小孔，耳周红肿化脓3月余	右耳垂前及耳垂处各一小孔，周围少量陈旧性分泌物，干痂附着	右耳周局部皮下软组织及腮腺区片状长T₂信号，病变伴不均匀轻度强化	鳃瘘感染引流术后
8	1岁	瘘管	出生后发现右颌下一小孔，伴红肿化脓2个月	右颌下红肿，有瘢痕	右颌下区片状等T₁、长T₂信号，病变不均匀强化，管状影向腮腺延伸，穿过腮腺达右侧外耳道区	右侧颌下瘘管伴感染?右侧皮下软组织增厚（炎性?）
9	10岁	囊肿	发现左耳后肿物1个月	左下颌角后上方耳后沟约2 cm×1.5 cm肿物	左腮腺区多发不规则片状等T₁、长T₂信号影明显强化	考虑左侧腮腺内不均匀回声肿块，首先考虑炎性
10	6岁	瘘管	左耳后红肿流脓4月余，左耳道间断流脓3月余	左耳后稍红肿，有瘢痕，中心白色小突起	左腮腺形态饱满，左腮腺区不均匀稍长T₂信号影，局部与表皮相通，不均匀强化	未查
11	1岁	瘘管	出生后发现左颈前一小凹，红肿化脓1个月	左颈前下颌角前下方皮肤红肿有瘢痕	左颌下区皮下软组织内及腮腺区不规则异常信号病变，局部边缘强化	未查
12	12岁	囊肿	发现右耳后肿物3个月	右耳后下颌角后上方及乳突前下方间，约 1.5 cm×1 cm质韧肿物	右耳后腮腺外侧局部皮下软组织内条片状等T₁、长T₂信号影明显强化	未查
13	5岁	囊肿	右耳前下方红肿化脓3年，加重1个月	右耳垂前下方可触及2 cm×1 cm类圆形、质韧肿物	右耳后腮腺外侧局部皮下软组织内条片状等T₁、长T₂信号影明显强化	未查
14	5岁	囊肿	左耳后红肿化脓半年	左耳后皮肤稍红肿，局部有瘢痕	左耳后腮腺后外侧小片状等T₁、稍长T₂信号影轻中度不均强化	未查
15	4岁	囊肿	发现左外道肿物1年，左耳后红肿2个月	左外耳道内可见黄豆肿物，左外耳道口一瘘口，左耳后有瘢痕	左耳周皮下不规则稍长T₁、长T₂信号病变边缘强化，下缘呈条索状强化，局部与腮腺分界不清	未查

编号	年龄	疾病	病史	查体	MRI报告	B超报告
1	8岁	囊肿	发现右耳后肿物半月余	右下颌角后上与乳突前下间一质韧肿物	右腮腺后缘囊性病变边缘强化，上缘管状影像向外耳道延伸	右侧耳前囊性肿块（内部不透亮），与耳道关系密切。
2	8岁	囊肿	发现右耳后红肿化脓6年	右耳后见瘢痕，肿物约2 cm×2 cm	右耳后皮下至腮腺区稍长T₁、长T₂信号影	右侧耳后患处低回声肿块
3	5岁	囊肿	发现右耳后肿物2月余	右下颌角后上方耳后沟直径约1 cm肿物	右腮腺外缘及耳后区条片状等T₁、长T₂信号强化，边缘为著	右侧腮腺内及右耳后低回声区，考虑炎性
4	2岁	瘘管	左耳后红肿化脓7个月	左耳垂前上一小孔，左耳后近耳垂处瘢痕	左耳周皮下腮腺区片状不规则稍长T₁、长T₂信号影边缘强化	未查
5	2岁	囊肿	右耳后反复红肿化脓1年余	右耳后皮肤稍红肿，局部有瘢痕	右耳后局部皮下组织内不规则条状长T₂信号强化，其内侧缘向腮腺表面延伸	未查
6	6岁	囊肿	发现右耳后肿物伴反复感染2年	右耳后乳突偏下处有瘢痕	右耳部局部皮下软组织内不规则条片状长T₂信号边缘轻度强化，其内侧缘向腮腺表面延伸	未查
7	6岁	瘘管	出生后发现右耳前、耳垂各一小孔，耳周红肿化脓3月余	右耳垂前及耳垂处各一小孔，周围少量陈旧性分泌物，干痂附着	右耳周局部皮下软组织及腮腺区片状长T₂信号，病变伴不均匀轻度强化	鳃瘘感染引流术后
8	1岁	瘘管	出生后发现右颌下一小孔，伴红肿化脓2个月	右颌下红肿，有瘢痕	右颌下区片状等T₁、长T₂信号，病变不均匀强化，管状影向腮腺延伸，穿过腮腺达右侧外耳道区	右侧颌下瘘管伴感染?右侧皮下软组织增厚（炎性?）
9	10岁	囊肿	发现左耳后肿物1个月	左下颌角后上方耳后沟约2 cm×1.5 cm肿物	左腮腺区多发不规则片状等T₁、长T₂信号影明显强化	考虑左侧腮腺内不均匀回声肿块，首先考虑炎性
10	6岁	瘘管	左耳后红肿流脓4月余，左耳道间断流脓3月余	左耳后稍红肿，有瘢痕，中心白色小突起	左腮腺形态饱满，左腮腺区不均匀稍长T₂信号影，局部与表皮相通，不均匀强化	未查
11	1岁	瘘管	出生后发现左颈前一小凹，红肿化脓1个月	左颈前下颌角前下方皮肤红肿有瘢痕	左颌下区皮下软组织内及腮腺区不规则异常信号病变，局部边缘强化	未查
12	12岁	囊肿	发现右耳后肿物3个月	右耳后下颌角后上方及乳突前下方间，约 1.5 cm×1 cm质韧肿物	右耳后腮腺外侧局部皮下软组织内条片状等T₁、长T₂信号影明显强化	未查
13	5岁	囊肿	右耳前下方红肿化脓3年，加重1个月	右耳垂前下方可触及2 cm×1 cm类圆形、质韧肿物	右耳后腮腺外侧局部皮下软组织内条片状等T₁、长T₂信号影明显强化	未查
14	5岁	囊肿	左耳后红肿化脓半年	左耳后皮肤稍红肿，局部有瘢痕	左耳后腮腺后外侧小片状等T₁、稍长T₂信号影轻中度不均强化	未查
15	4岁	囊肿	发现左外道肿物1年，左耳后红肿2个月	左外耳道内可见黄豆肿物，左外耳道口一瘘口，左耳后有瘢痕	左耳周皮下不规则稍长T₁、长T₂信号病变边缘强化，下缘呈条索状强化，局部与腮腺分界不清	未查