Branchial cleft anomaly - Revision history

Rossdonaldson1: /* Evaluation */

2022-01-08T06:03:33Z

Evaluation

← Older revision		Revision as of 06:03, 8 January 2022
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	==Evaluation==		==Evaluation==
			[[File:PMC4420443 jns-3-34.f1.png\|thumb\|Fourth branchial anomaly presenting with a lateral neck mass in a neonate. Left lateral neck X-ray finding : An air-fluid level within the mass in the left anterior neck. (Arrows)]]
	[[File:PMC4729717 13244 2015 454 Fig2 HTML.png\|thumb\|MRI of wwo-year-old child with a rounded and well-defined T1 isointense, T2 hyperintense lesion with thin peripheral enhancement (thick white arrows). It is located posterior to the right submandibular gland (thin white arrow) and anterior to the sternocleidomastoid muscle and carotid sheath (asterisk). This was confirmed to represent a second branchial cleft cyst following surgical excision.]]		[[File:PMC4729717 13244 2015 454 Fig2 HTML.png\|thumb\|MRI of wwo-year-old child with a rounded and well-defined T1 isointense, T2 hyperintense lesion with thin peripheral enhancement (thick white arrows). It is located posterior to the right submandibular gland (thin white arrow) and anterior to the sternocleidomastoid muscle and carotid sheath (asterisk). This was confirmed to represent a second branchial cleft cyst following surgical excision.]]
	[[File:MPX2324 synpic56947.png\|thumb\|23 y/o with rim enhancing fluid and gas collection originating from the left pyriform sinus and extending inferiorly to the left thyroid lobe from an infected 4th branchial cleft sinus.]]		[[File:MPX2324 synpic56947.png\|thumb\|23 y/o with rim enhancing fluid and gas collection originating from the left pyriform sinus and extending inferiorly to the left thyroid lobe from an infected 4th branchial cleft sinus.]]

Rossdonaldson1: /* Evaluation */

2022-01-08T06:01:50Z

Evaluation

← Older revision		Revision as of 06:01, 8 January 2022
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	==Evaluation==		==Evaluation==
	[[File:PMC4729717 13244 2015 454 Fig2 HTML.png\|thumb\|MRI of wwo-year-old child with a rounded and well-defined T1 isointense, T2 hyperintense lesion with thin peripheral enhancement (thick white arrows). It is located posterior to the right submandibular gland (thin white arrow) and anterior to the sternocleidomastoid muscle and carotid sheath (asterisk). This was confirmed to represent a second branchial cleft cyst following surgical excision.]]		[[File:PMC4729717 13244 2015 454 Fig2 HTML.png\|thumb\|MRI of wwo-year-old child with a rounded and well-defined T1 isointense, T2 hyperintense lesion with thin peripheral enhancement (thick white arrows). It is located posterior to the right submandibular gland (thin white arrow) and anterior to the sternocleidomastoid muscle and carotid sheath (asterisk). This was confirmed to represent a second branchial cleft cyst following surgical excision.]]
			[[File:MPX2324 synpic56947.png\|thumb\|23 y/o with rim enhancing fluid and gas collection originating from the left pyriform sinus and extending inferiorly to the left thyroid lobe from an infected 4th branchial cleft sinus.]]

	===Workup===		===Workup===
	*Consider one of the following:		*Consider one of the following:

Rossdonaldson1: /* Clinical Features */

2022-01-08T05:58:37Z

Clinical Features

← Older revision		Revision as of 05:58, 8 January 2022
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	==Clinical Features==		==Clinical Features==
			[[File:PMC4196451 ijo-26-263-g001.png\|thumb\|First branchial cleft fistula opening in the middle ear and mastoid cholesteatoma.]]
	*Lateral neck soft tissue anatomy		*Lateral neck soft tissue anatomy
	*Typically asymptomatic unless superinfected causing cellulitis or abscess formation		*Typically asymptomatic unless superinfected causing cellulitis or abscess formation

Rossdonaldson1: /* Evaluation */

2022-01-08T05:56:45Z

Evaluation

← Older revision		Revision as of 05:56, 8 January 2022
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	==Evaluation==		==Evaluation==
	*[[Ultrasound]]		[[File:PMC4729717 13244 2015 454 Fig2 HTML.png\|thumb\|MRI of wwo-year-old child with a rounded and well-defined T1 isointense, T2 hyperintense lesion with thin peripheral enhancement (thick white arrows). It is located posterior to the right submandibular gland (thin white arrow) and anterior to the sternocleidomastoid muscle and carotid sheath (asterisk). This was confirmed to represent a second branchial cleft cyst following surgical excision.]]
	*[[CT]]		===Workup===
	*[[~~mri\|~~MRI]]		*Consider one of the following:
			**[[Ultrasound]]
			**[[CT]]
			**[[MRI]]

			===Diagnosis===
			*Typically via imaging (see workup for options)

	==Management==		==Management==

Rossdonaldson1: /* Background */

2022-01-08T05:53:52Z

Background

← Older revision		Revision as of 05:53, 8 January 2022
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	==Background==		==Background==
	[[File:PMC4729717 13244 2015 454 Fig1 HTML.png\|thumb\|Frontal schematic representation of a 5-mm human embryo at the fifth week of gestation. Sagittal sections taken through the branchial apparatus demonstrate the anatomic relationship of external clefts and internal pouches as well as the derivation of important head and neck structures. The sixth arch is very small and not visualised as a separate, discrete structure from pouch 4/5.]]		[[File:PMC4729717 13244 2015 454 Fig1 HTML.png\|thumb\|Frontal schematic representation of a 5-mm human embryo at the fifth week of gestation. Sagittal sections taken through the branchial apparatus demonstrate the anatomic relationship of external clefts and internal pouches as well as the derivation of important head and neck structures. The sixth arch is very small and not visualised as a separate, discrete structure from pouch 4/5.]]
			[[File:PharyngealArchHuman.jpg\|thumb\|The pharyngeal arches as seen during embryonic development.]]
	*During 4th week of embryonic development, five branchial arches grow into distinct parts of head and neck		*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		*All consist of arteries, nerves, muscle, skeletal tissue

Rossdonaldson1: /* Background */

2022-01-08T05:52:21Z

Background

← Older revision		Revision as of 05:52, 8 January 2022
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	==Background==		==Background==
			[[File:PMC4729717 13244 2015 454 Fig1 HTML.png\|thumb\|Frontal schematic representation of a 5-mm human embryo at the fifth week of gestation. Sagittal sections taken through the branchial apparatus demonstrate the anatomic relationship of external clefts and internal pouches as well as the derivation of important head and neck structures. The sixth arch is very small and not visualised as a separate, discrete structure from pouch 4/5.]]
	*During 4th week of embryonic development, five branchial arches grow into distinct parts of head and neck		*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		*All consist of arteries, nerves, muscle, skeletal tissue

ClaireLewis: /* Evaluation */

2019-10-05T20:45:13Z

Evaluation

← Older revision		Revision as of 20:45, 5 October 2019
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	==Evaluation==		==Evaluation==
	*Ultrasound		*[[Ultrasound]]
	*CT		*[[CT]]
	*MRI		*[[mri\|MRI]]

	==Management==		==Management==

ClaireLewis at 18:19, 14 September 2019

2019-09-14T18:19:17Z

← Older revision		Revision as of 18:19, 14 September 2019
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	==Background==		==Background==
	During ~~the~~ 4th week of embryonic development, ~~there are~~ five branchial arches ~~that~~ grow into distinct parts of ~~the~~ head and neck~~, all of which~~ consist of arteries, nerves, ~~muscles~~, ~~and~~ skeletal tissue. If ~~the branchial~~ arches fail to fuse~~, a~~ soft tissue anomaly on ~~the~~ lateral ~~aspect of the~~ neck may form, ~~which is~~ called a branchial cleft anomaly~~. The range of anomalies~~ include cysts (most common), fistulas, ~~and~~ sinus tracts~~. The second~~ branchial cleft anomalies ~~are the~~ most common.		*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 ~~mucous~~ drainage from cutaneous opening at lateral neck		**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==

Hirokoa33 at 23:18, 24 October 2017

2017-10-24T23:18:09Z

← Older revision		Revision as of 23:18, 24 October 2017
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	==Management==		==Management==
	*Surgical excision is definitive treatment (high risk of recurrence of not completely excised)		*Surgical excision is definitive treatment (high risk of recurrence if not completely excised)
	*Antibiotics if superinfection present		*Antibiotics if superinfection present

Mholtz: Mholtz moved page Branchial cleft to Branchial cleft anomaly

2017-10-21T08:12:56Z

Mholtz moved page Branchial cleft to Branchial cleft anomaly

← Older revision	Revision as of 08:12, 21 October 2017
(No difference)