61-year-old male with subacute cognitive impairment and ataxia

Abstract

Branchial cleft anomalies are common differential diagnosis of neck masses. However, depending on the origin (1st, 2nd, 3rd or 4th arch), this pathology presents at different locations as cyst, sinus and fistula. Incomplete excision or incision and drainage of infected branchial cleft anomalies (cystic presentation) can lead to multiple recurrences. Appropriate radiology is imperative to make a correct diagnosis and to achieve complete excision to prevent recurrence. Our case series highlights the mode of presentation, appropriate radiology and management for each type of branchial cleft anomalies. Data of 27 patients with the diagnosis of branchial cleft anomaly and treated in the department of Otolaryngology-Head and Neck Surgery in a tertiary care referral centre in last 5 years was analysed retrospectively. Demographic data in terms of age, sex, laterality, clinical presentation, duration of symptoms and radiological investigations if any were recorded. The mean age at presentation was 22.1 years in this series of 27 cases including six (22.2%) recurrent cases. Most common clinical presentation was discharging sinus (59.25%) followed by cystic neck swelling (33.3%). Second branchial cleft anomalies were commonest (51.8%) followed by first branchial cleft anomalies (29.6%). Appropriate radiology was available for 17 (62.9%) patients. Branchial cleft anomaly is an important differential diagnosis of neck mass. Appropriate radiology helps in complete excision and prevents recurrences. Recurrent cases pose surgical challenge owing to fibrosis from previous surgery which further increases the chances of incomplete excision.