First branchial cleft anomalies in children: long-term outcome in 16 patients.

Abstract

Introduction: First branchial cleft anomalies (FBCA) are rare congenital head and neck malformations, often subject to incorrect diagnosis and treatment. We present our experience with FBCA, focusing on clinical presentation, diagnosis, perioperative relation to the facial nerve, surgical approach, complications and patient satisfaction.

Methods: A consecutive cohort of 16 patients undergoing surgical treatment for FBCA between 1999 and 2021 was analyzed. Demographic and clinical information was extracted from their medical records. Additionally 14 patients were interviewed by telephone to assess postoperative outcomes and patient satisfaction using a Likert scale.

Results: Sixteen patients (11 females, 5 males) were surgically treated at an age ranging from 7 months to 13 years. Type I and type II FBCA were evenly distributed. Lesions presented as cysts (n = 4), sinuses (n = 7) or fistulas (n = 5). The main symptoms were swelling, inflammation and discharge. Otologic symptoms were present in 31%. In 80% of patients, magnetic resonance imaging was needed to reach the correct diagnosis. Ten patients (63%) had a history of a surgical attempt in another center before definitive surgical treatment in our center. Complete excision was accomplished in all patients. Postoperative complications included limited Frey syndrome (n = 4), temporary hypertrophic scarring (n = 4), minimal paresis of the marginal mandibular branch of the facial nerve (n = 1) and limited external auditory canal stenosis (n = 1). One patient experienced a recurrence at the level of the external auditory canal, that required minor revision surgery. The average patient satisfaction score was 13.64 out of 15.

Conclusion: Thorough clinical examination, awareness of the different entities and awareness of expert head and neck radiological advice are crucial for correct FBCA diagnosis and typing, determining the correct surgical approach. It is crucial that patients diagnosed with FBCA undergo surgery in specialized centers. Despite the challenging surgery and its potential complications, the overall patient satisfaction remains high post- treatment.