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A Study of 39 Cases and a Review of the Literature

Jean-Michel Triglia, MD; Richard Nicollas, MD; Vincent Ducroz, MD; Peter J. Koltai, MD; Erea-Noël Garabedian, MD

Arch Otolaryngol Head Neck Surg. 1998;124:291-295.

Objectives  To identify the clinical and anatomical presentations and to discuss the guidelines for surgical management of anomalies of the first branchial cleft.

Design  Retrospective study.

Setting  Three tertiary care centers.

Patients  Thirty-nine patients with first branchial cleft anomalies operated on between 1980 and 1996.

Intervention  All patients were treated surgically. Complete removal of the lesion required superficial parotidectomy with facial nerve dissection in 36 cases. The relationship of the facial nerve and anomalies is discussed.

Results  Anatomically, 3 types of first branchial cleft anomalies are identified: fistulas (n=11), sinuses (n=20), and cysts (n=8). Clinically, 3 types of presentation are noted: chronic purulent drainage from the ear (n=12), periauricular swelling in the parotid area (n=18), and abscess or persistent fistula in the neck located above a horizontal plane passing through the hyoid bone (n=21). A membranous attachment between the floor of the external auditory canal and the tympanic membrane was observed in 10% of cases. The facial nerve was located lateral to the anomaly in 39% of cases.

Conclusions  Before definitive surgery, many patients (n=17) underwent incision and drainage for infection owing to the difficulties in diagnosing this anomaly. Wide exposure is necessary in most cases, and a standard parotidectomy incision allows adequate exposure of the anomaly and preservation of the facial nerve. Complete removal without complications depends on a good understanding of regional embryogenesis, a knowledge of the circumstances surrounding discovery, an awareness of the different anatomical presentations, and a readiness to identify and protect the facial nerve during resection.

From the Departments of Pediatric Otorhinolaryngology, La Timone Hospital, Marseille, France (Drs Triglia and Nicollas), and Trousseau Hospital, Paris, France (Drs Ducroz and Garabedian), and the Division of Pediatric Otolaryngology, Albany Medical Center, Albany, NY (Dr Koltai).

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