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ORIGINAL ARTICLE
Year : 2017  |  Volume : 19  |  Issue : 1  |  Page : 17-19

Recurrence of branchial anomalies after surgical excision: Rate and associated factors


1 Otolaryngology, Head & Neck Department, King Abdulaziz University, Jeddah, Saudi Arabia
2 Otolaryngology, Head & Neck Department, King Abdullah Medical City, Makkah, Saudi Arabia
3 Head of ORL Department, King Abdullah Medical City, National Guard, Jeddah, Saudi Arabia

Date of Web Publication7-Jan-2020

Correspondence Address:
MD Ibrahim S Alnoury
Consultant ORL Head and neck, Paediatrics ENT, King AbdulAziz University Hospital, Jeddah
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-8491.275308

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  Abstract 


Background: Branchial anomalies are uncommon of embryonic development that is commonly discovered by otolaryngologists. The recognition of the development of branchial apparatus and their anomalies is important during surgery. Post-operative recurrence is a rare, however possible complication.
Objectives: To investigate the post-surgical recurrence among patients who underwent surgical excision of the branchial cleft cysts and its influencing factors.
Subjects and methods: This is a retrospective study of twenty cases of branchial anomalies presented to the department of Otolaryngology, Head and Neck Surgery, King Abdul-Aziz Medical City, National Guard, Jeddah, Saudi Arabia, over a period of 12 years from October, 2003 to October, 2015. Patient’s gender, type of lesion (cysts and fistulae), side of lesion (right and left), surgeon (ENT versus non-ENT), FNA histopathological and radiological findings as well as operative complications were noted from the case records. Primary diagnosis was done through FNAC and radiology whereas histopathological examination as a final diagnosis was done and available for all included cases. All patients were operated upon through surgical excision.
Results: Twenty patients were included in the study; 13 males and 7 females. Recurrence was reported in only one case (5%). Histopathologically, all cases were benign looking cells. The recurrent lesion was found in a male patient, on right-side, the lesion was fistulous in nature, surgery done by non-ENT surgeon; Fine-needle aspiration cytology (FNAC) was not done, no radiological finding, and with history of postoperative complications. No statistically significant association was found between recurrence of the lesion and all the studied factors, p>0.05
Conclusion: Recurrence of branchial anomalies after surgical excision is rare. However, further multi-centric research is recommended to identify the possible predictors for recurrence.

Keywords: Brancial cyst; Branchial fistula; Recurrence; Excision


How to cite this article:
Alnoury IS, Alghamdi SA, Rayes MO, Etwadi HM, Algarni M. Recurrence of branchial anomalies after surgical excision: Rate and associated factors. Saudi J Otorhinolaryngol Head Neck Surg 2017;19:17-9

How to cite this URL:
Alnoury IS, Alghamdi SA, Rayes MO, Etwadi HM, Algarni M. Recurrence of branchial anomalies after surgical excision: Rate and associated factors. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2017 [cited 2023 Jan 30];19:17-9. Available from: https://www.sjohns.org/text.asp?2017/19/1/17/275308




  Introduction Top


The altered development of the branchial apparatus during embryogenesis, throughout the period between the 2nd and 6th-7th weeks of fetal life resulted in branchial anomalies. The persistence of branchial remnants can lead to the development of cysts, sinuses, fistulas, or islands of cartilage [1]. Branchial cysts are considered to be entrapped remnants of branchial cleft or sinuses; sinuses are remnants of cleft or pouches; and fistulae result from persistence of both pouch and cleft [2].

Branchial anomalies are uncommon of embryonic development that are commonly discovered by otolaryngologists as nearly 17% of all pediatric cervical masses are due to branchial anomalies. [3]

Both males and females are affected by branchial cleft cysts at almost equal rates and usually occur during infancy and childhood, although they may be discovered at any time during the lifespan [2].

The recognition of the development of branchial apparatus and their anomalies is important during surgery, as vital structures like facial nerve and parotid are in intimate relation with many of these anomalies [3]. Post-operative recurrence is a rare, however possible complication [3].

This study aimed to investigate the post-surgical recurrence among patients who underwent surgical excision of the branchial cleft cysts and its influencing factors.


  Subjects and Methods Top


This is a retrospective study of twenty cases of branchial anomalies presented to the department of Otolaryngology, Head and Neck Surgery, King Abdul Aziz Medical City, National Guard, Jeddah, Saudi Arabia, over a period of 12 years from October 2003 to October 2015. Ethical approval was obtained from the Regional Research and Ethics Committee, King Abdul- Aziz Medical city, National Guard, Jeddah. Patient’s gender, type of lesion (cysts and fistulae), side of lesion (right and left), surgeon (ENT versus non-ENT), FNA, histopathological and radiological findings as well as operative complications were noted from the case records. Primary diagnosis was done through FNA and radiology whereas histopathological examination as a final diagnosis was done and available for all included cases. All patients were operated upon through surgical excision.

Recurrence of the lesion was assessed and correlated with different factors that could lead to its recurrence. Fischer Exact/Chi-square statistical tests were performed and a p-value less than 0.05 was considered statistically significant.


  Results Top


Twenty patients were included in the study, 13 males and 7 females. Recurrence was reported in only one case (5%). Histopathologically all cases were benign looking cells. [Table 1] summarizes the association between post-operative recurrence and different factors. The recurrent lesion was found in a male patient, on right- side, the lesion was fistulous in nature, surgery done by non-ENT surgeon; Fine-needle aspiration cytology (FNAC) was not done, no radiological finding, and with history of postoperative complications. Since, it was only one case, no statistically significant association was found between recurrence of the lesion and all the studied factors, p>0.05.
Table 1: Factors associated with post-operative recurrence of brachial anomalies

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  Discussion Top


In the present study, twenty patients with branchial anomalies were studied retrospectively over a period of 12 years yielded a recurrence rate of 5%. In the case series by Ford et al., [4] the postoperative recurrence rate was 3% while in the case series by Prasad et al., [3] the recurrence rate was 1.2%. It has been recommended that using magnification loops or the microscope at the time of dissection may enhance complete removal and preventing recurrences [3].

An initial correct diagnosis is essential because it has been reported that recurrence rates after surgical excision of branchial anomalies are 14% and 22% with previous infection and surgery, respectively, whereas the recurrence rate for primary lesion is 3% [5].

Regarding the anatomical types of the lesion, we had 14 cysts (70%) and 6 fistula (30%). This is contrary to what has been reported by Prasad, et al [3] who reported higher incidence of fistula (58.8%) than cyst (41.12%). Choi and Zalzal [6] reported a maximum incidence of branchial sinuses, followed by fistula.

In the present study, branchial anomalies were more reported among males (65%). This is comparable to what has been reported by others where 55.9% were males and 44.1% were females [3].

Regarding the site of the lesion, 45% of lesions were on the right side and the remaining 55% were on the left side. In an Indian study, [3] the incidence of these anomalies was more on the right side (57.1%) than left side (42.9%).

Concerning investigations, FNAC was done in 50% of branchial anomalies cases compared to 16.7% of cases of branchial cysts in an Indian study [3]. In the only recurrent case of our series, FNAC was not done. Fine-needle aspiration cytology is useful for reaching a preoperative diagnosis [7].

Operative complications were reported in 15% of cases whereas in a study carried out by others [3] reported that 14.7% of cases developed post-operative infection. The recurrent lesion observed in this study was found in a male patient, on right-side, the lesion was fistulous in nature, surgery done by non-ENT surgeon; FNA was absent, no radiological finding, and with history of postoperative complications. However, due to small sample size, power of the statistical tests was not enough to detect significant association between recurrence and these factors. Therefore, a multicentric study included larger number of cases is highly recommended to explore in a better way the influence of these factors on recurrence of the lesion post-operatively.

This study was limited by two important factors. First, the inclusion of cases from only one center which affects the generalizability of results and second the relatively small sample size that yielded only one case of recurrence which doesn’t allow studying the associated factors statistically.

Conclusively, recurrence of branchial anomalies after surgical excision is rare. However, further multi-centric research is recommended to identify the possible predictors for recurrence.



 
  References Top

1.
Papadogeorgakis N, Petsinis V, Parara E, Papaspyrou K, Goutzanis L, Alexandridis C. Branchial cleft cysts in adults. Diagnostic procedures and treatment in a series of 18 cases. Oral Maxillofacial Surg. 2009; 13(2): 79-85  Back to cited text no. 1
    
2.
Choi SS, Zalzal GH. Branchial Anomalies: A review of 52 cases. Laryngoscope. 1995; 105:909-913  Back to cited text no. 2
    
3.
Prasad SC, Azeez A, Thada ND, Rao P, Bacciu A, Prasad KC. Branchial Anomalies: Diagnosis and Management. Intern J Otolaryngol. 2014; Article ID 237015: 9 pages.  Back to cited text no. 3
    
4.
Ford GR, Balakrishnan A, Evans JNG, Bailey CM. Branchial cleft and pouch anomalies. J Laryngol Otol. 1992; 106(2):. 137-143.  Back to cited text no. 4
    
5.
Reiter D. Third branchial cleft sinus: an unusual cause of neck abscess. Intern J Pediat Otorhinolaryngol. 1982; 4(2): 181-186.  Back to cited text no. 5
    
6.
Choi SS, Zalzal GH. Branchial anomalies: a review of 52 cases. Laryngoscope 1995; 105(9) part 1: 909-913  Back to cited text no. 6
    
7.
Valentino M, Quiligotti C, Carone L. Branchial cleft cyst. J Ultrasound. 2013; 16:17-20.  Back to cited text no. 7
    



 
 
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Introduction
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