31例鳃裂发育畸形临床诊治分析

目的探讨鳃裂发育畸形的临床诊治。方法回顾性分析31例鳃裂瘘管、窦道及囊肿诊治情况,其中第一鳃裂瘘管7例,第二鳃裂瘘管6例、鳃裂窦道及囊肿12例,第三鳃裂瘘管6例。初次手术者16例,复发再次手术者15例。结果经合理用药,术中熟悉瘘管行走途径,精细解剖,彻底切除瘘管、窦道及囊肿,1例出现面神经下颌缘支不全麻痹;1例出现咽瘘,经换药后痊愈。其中27例随访1年以上,截止目前无1例再次复发。结论熟悉各型鳃裂畸形的发病机制及颈部解剖,合理选择手术时机是治愈该种疾病的关键。     

功能性颈清扫术在复发性鳃裂畸形治疗中的应用

目的:探讨功能性颈清扫术在复发性鳃裂畸形治疗中的应用。方法:回顾性分析我科采用功能性颈清扫术治疗复发性鳃裂畸形(瘘管和囊肿)患者15例的资料。结果:13例切口一期愈合,2例二期愈合,1例术后饮水呛咳,1个月后自行恢复,1例术后遗留Horner综合征。随访2个月～6年,除2例失访外,无一例复发。结论:功能性颈清扫术对于多次复发的第二、第三鳃裂畸形(瘘管和囊肿)是一种安全有效的治疗手段。     

瘘管衬里外翻法治疗颈侧第3鳃裂瘘管1例

颈侧第 3鳃裂瘘管的外口通常在胸锁乳突肌中 1 /3段前缘皮肤内 ,内口在同侧梨状隐窝顶部。行瘘管造影时 ,可能因窦道内有反复感染等原因造成阻塞而不易获得成功 ,术后尚有 3%～ 2 1 %的复发率〔3〕。我们采用瘘管衬里外翻法治疗 1例复发性颈左侧第 3鳃裂瘘管 ,效果满意。现报告如下。　　患者 ,男 ,2 2岁。于 1 980年 3月 1 1日入院。平素体健。 5年前在外院手术摘除颈左侧第 3鳃裂瘘管 ,术后约 2年颈左侧出现肿痛、化脓并破溃 ,排脓后疮口可暂时愈合 ,但不久又复发。入院时见颈左胸锁乳突肌中段下方的皮肤有一约 3ｃｍ× 4ｃｍ破溃感染区 ,…     

择区性颈清扫术治疗复发性鳃裂畸形

目的:探讨择区性颈清扫术治疗复发性鳃裂畸形的疗效.方法:回顾性分析18例复发性鳃裂畸形病例资料.根据鳃裂畸形的胚胎学和解剖学特点,选择不同类型的择区性颈清扫术式治疗.手术解剖、保护重要的血管神经,应用整块切除原则根除病变组织、瘢痕、炎性肉芽.结果:18例患者中,16例切口Ⅰ期愈合,2例术后切口局部感染,经换药后愈合.1例复发性第一鳃裂瘘管术后出现暂时性面瘫, 术后2个月完全恢复.1例复发性第四鳃裂瘘管,术后出现暂时性声带麻痹,1个月后恢复.随访12～78个月,平均35个月,所有病例未见复发.结论:择区性颈清扫术治疗复发性鳃裂畸形,安全、有效.     

颈部囊肿与瘘管的诊断和治疗

目的总结颈部囊肿与瘘管的诊治经验.方法93例行手术治疗,其中鳃裂囊肿15例,鳃裂瘘管10例,皮样囊肿1例,囊状淋巴管瘤4例,甲状舌骨囊肿37例,甲状舌管瘘管25例,癌性淋巴液囊肿1例,随访1～10年.结果93例中,囊性淋巴管瘤1例复发后失访,另1例行2次手术,癌性淋巴液囊肿1例半年后死于肺转移,鳃裂瘘管2例3次手术,甲状舌管瘘管1例复发,鳃裂瘘管术后1例迟发性面瘫,一次手术治愈,无术后并发症.结论颈部囊肿与瘘管的诊断除依据术前检查外,主要是依据术中的发现和术后病理检查.B超、CT等是有效的辅助检查手段.治疗上应彻底切除囊壁与瘘管,避免复发.术中应避免损伤颈部的大血管和神经.甲状舌管瘘管须切除舌骨中段2cm,这是防止术后复发的关键.     

第一鳃裂瘘管切除术中面神经解剖的临床意义

目的探讨面神经解剖在第一鳃裂瘘管切除术中的意义。方法回顾性分析我科2005～2010年收治的23例第一鳃裂瘘管患者的临床资料。所有病例均在明视面神经的情况下完整切除病变及周围瘢痕组织。10例无手术史的患者行面神经总干解剖法;13例有术前切开引流及瘘管切除史的患者行面神经下颌缘支解剖法。结果所有患者手术切口均I期愈合。1例患者术后出现一过性面瘫,术后1周时完全恢复。5例行外耳道部分皮肤和软骨切除的患者术后均无外耳道狭窄及听力下降。随访9个月～6年,23例患者均未见复发。结论第一鳃裂瘘管与面神经关系密切,面神经解剖在第一鳃裂瘘管切除术中可有效防止面神经不可逆损伤。     

第三、四鳃裂畸形的诊断与治疗

目的 探讨第三、四鳃裂畸形的临床特征、诊断方法以及手术治疗的技巧与疗效.方法 回顾性分析2002年1月～2013年3月间21例第三、四鳃裂畸形的临床资料.左侧19例,右侧2例.年龄9～53岁,其中40岁以下16例（占76.2％）.完全性瘘管10例,不完全性瘘管11例,其中明确存在梨状窝内瘘口者16例.均采用全麻下颈淋巴结清扫方式行手术治疗,同时行同侧甲状腺腺叶切除16例,行甲状腺部分切除5例.结果 病理均证实为鳃裂畸形.术后咽瘘1例,经换药保守治疗愈合.术后暂时性喉返神经麻痹1例,术后1月复查恢复正常.术后随访均1年以上,未见复发.结论 反复发作的左侧颈根部脓肿或化脓性甲状腺炎应考虑到第三、四鳃裂畸形的可能;采用颈清扫的手术方式行病变区域整块切除并注重内瘘口的处理是防止复发的关键。     

感染性第三鳃裂瘘管的手术时机选择及治疗分析

目的探讨感染性第三鳃裂瘘管的手术时机选择和治疗。方法回顾分析四川省人民医院耳鼻咽喉头颈外科2010年1月~2015年12月收治的9例感染性第三鳃裂瘘管患者的临床资料,9例患者均在全麻下行颈淋巴结清扫术。术中根据不同情况进行了相应的处理。结果9例患者中3例患者有明显内瘘口,6例患者未发现明显内瘘口,所有患者伤口愈合良好,无一例发生感染。术后随访6~54个月,平均24个月,术后均未复发。结论对于感染性第三腮裂瘘管的患者,手术切除瘘管组织是有效的治疗手段。术前的准确诊断,良好的手术时机选择和术中对于瘘管组织的彻底切除是提高治疗成功率以及防止复发的关键。     

选择性颈清扫术在复发性第二三鳃裂瘘管术中的应用

由于鳃裂瘘管与颈部重要神经、血管关系密切,手术切除不彻底,易造成反复感染.对于复发者,常规手术方法更难治愈.我们采用选择性颈清扫术,整块切除病变组织,保留颈内动静脉、神经、胸锁乳突肌, 治疗8例复发性第二、三鳃器瘘管患者,术后随访2～10年,无一例复发,总结如下.     

先天性第四鳃裂畸形的走行探讨和治疗经验

目的 对先天性第四鳃裂畸形的走行进行探讨并总结治疗经验.方法 回顾性分析2005年1月至2012年4月收治的12例第四鳃裂畸形患者的临床资料,对第四鳃裂畸形的走行及其手术方式进行分析.结果 12例患者术中均显露喉返神经,10例行甲状腺腺叶部分切除,其中2例行Ⅱ、Ⅲ、Ⅳ及Ⅵ区颈清扫术；此10例病变均行于甲状腺后方,其中7例进入梨状窝尖；1例术前检查示内瘘口于梨状窝尖,但术中未探及内瘘口；1例止于颈段食管侧壁；1例开口于颈段食管.另2例患者中1例病变以条索止于甲状腺外侧,1例为甲状腺外侧囊肿.本组无瘘管绕过舌下神经的病例,也没有延伸至纵隔的病例.1例患者术中切断左侧喉返神经,立即行喉返神经端端吻合术,术后左侧声带麻痹.本组患者术后随访8～88个月,中位随访时间24个月,10例无复发,1例复发,1例失访.结论 本组病例的先天性瘘管走行与理论走行不符合.病变大多与甲状腺和喉返神经关系密切,需保护喉返神经,处理甲状腺.对难以辨认瘘管走行的复发病例应行上至二腹肌下的Ⅱ、Ⅲ、Ⅳ及Ⅵ区颈清扫术.术中未找到内瘘口者,应进行长期随访.     

Unusual presentation of a first branchial cleft

An atypical case of a first branchial cleft presenting with a cutaneous fistula and an epidermoid cyst of the external auditory canal is reported. The relevant embryology of the branchial apparatus is summarized, and variations of first branchial anomalies are discussed. The relationship with a congenital cholesteatoma is discussed.     

Recurrence of a deep neck infection: a clinical indication of an underlying congenital lesion

OBJECTIVE: To discuss the computed tomographic (CT) and clinical findings of those entities that may present as recurrent deep neck infections. PATIENTS AND METHODS: Twelve patients with recurrent deep neck infections and CT scans were retrospectively identified since 1990. Their CT scans and medical histories were reviewed. The diagnosis was pathologically confirmed in all cases. RESULTS: The CT scans revealed an abscess or a localized infected cyst in the deep soft tissues of the neck, with varying degrees of associated inflammatory change in the adjacent soft tissues. The diagnoses in these cases included 1 first branchial cleft cyst, 3 second branchial cleft cysts, 1 third branchial cleft cyst, 2 fourth branchial cleft cysts, 2 infected lymphangiomas, 2 thyroglossal duct cysts, and 1 cervical thymic cyst. CONCLUSIONS: Most deep neck infections are the result of suppurative adenitis. The location of the primary focus is usually from the mucosa of the upper aerodigestive tract or from an odontogenic source. Less common causes are perforations due to a foreign body, thrombophlebitis of the internal jugular vein, or osteomyelitis of the spine. Recurrences in these situations are unusual. Less commonly, congenital lesions can present as deep neck infections, and recurrences are common. Our cases suggest that the recurrence of a deep neck infection should alert the physician to the possibility of an underlying congenital lesion and that CT is helpful in the early recognition of these lesions.     

Oropharyngeal trauma mimicking a first branchial cleft anomaly

We present a unique and challenging case of a remnant foreign body that presented to us in a child disguised as a strongly suspected congenital branchial cleft anomaly. This case entailed oropharyngeal trauma, with a delayed presentation as a retroauricular cyst accompanied by otorrhea that mimicked the classic presentation of an infected first branchial cleft anomaly. During surgical excision of the presumed branchial anomaly, a large wooden stick was found in the tract. The diagnostic and therapeutic obstacles in the management of such cases are highlighted. In addition to exploring the existing literature, we retrospectively analyzed a plausible explanation of the findings of this case. Laryngoscope, 126:E224–E226, 2016     

Diagnosis and treatment of branchial cleft anomalies in UKMMC: a 10-year retrospective study

Branchial cleft anomalies result from abnormal persistence of branchial apparatus, which is located at the lateral part of the neck. These occur due to failure of obliteration of the branchial apparatus during embryonic development. Differential diagnoses of lateral neck mass are salivary gland or neurogenic neoplasms, paragangliomas, adenopathies, cystic hygroma or cystic metastasis from squamous cell carcinoma or thyroid papillary carcinoma. Clinically, a branchial cyst is smooth, round, fluctuant and non-tender, and usually occurs over the upper part of the neck, anterior to the sternocleidomastoid muscle. Sometimes, it may present as infected cyst (or abscess), a sinus or fistula. Surgical excision is the definitive treatment for branchial anomalies. The objective of the work was to study the demographic data, clinical presentation, definite diagnostic workup and treatment of patients diagnosed with branchial anomalies. This is a retrospective study of 26 patients who were diagnosed with branchial anomalies (branchial cyst and fistula), of which only 12 patients had data available between July 1999 and June 2009 at the Otorhinolaryngology, Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre. Twelve cases of branchial anomalies were seen, in which 10 patients had second branchial cyst anomalies, 1 had third branchial fistula and 1 had bilateral branchial lesion. There were seven females and five males. The age of the patients varied over a wide range (4–44 years), but the majority of the patients were in their second and third decade of life. All branchial anomalies occurred at the classical site; eight patients had left-sided neck lesion. Correct clinical diagnosis was made only in five patients (41.6 %). All patients underwent surgical excision with no reported recurrence. Branchial anomalies are frequently forgotten in the differential diagnosis of lateral neck swelling. Diagnosis is usually delayed, leading to improper treatment. The diagnosis of patients who present with lateral neck cystic swelling with or without episodes of recurrent neck abscess should be considered with a high suspicion for branchial anomalies. FNA cytology is a good investigative tool in reaching toward a diagnosis of branchial lesion, with the concurrent assistance of radiological modalities. Surgical excision is the gold standard treatment of lesions of branchial anomalies.     

Diagnostic and therapeutic problems posed by a congenital lateral fistula of the neck (author's transl)]

Cysts and congenital lateral cervical fistulas are related to the persistance of the normally transitory branchial pouches and their embryologico-anatomic arrangement. Due to this fact they have a preferential topography. An atypical fistula of the second branchial cleft is reported. It is a congenital supra-hyoidian lateral cervical fistula with an intra-parotid route which terminates in the tonsils. The extreme variability of the external orifice, the pathogenic nature of the internal orifice and of the fistular route, as well as the initial discovery of the facial nerve and tonsillectomy in lateral fistulas of the neck are, by the same occasion, brought to mind.     

Second branchial cleft cyst causing internal jugular vein thrombosis — A case report

The branchial cleft cyst also known as lateral cervical cyst is usually present in the lateral part of neck deep to sternocleidomastoid muscle at the junction of its upper third and lower two thirds. Branchial cysts are known for repeated infection with sudden increase in size and pain and for its recurrence. Thrombosis of major vessels of neck secondary to recurrent infection and inflammation of branchial cyst is extremely rare. Here we present the first case of internal jugular vein thrombosis; a rare complication seen with branchial cyst in a 54-year-old male. The patient was treated initially with antibiotics followed by excision of cyst and ligation of internal jugular vein without any complication. Key Message Thrombosis of internal jugular vein secondary to recurrent infection and inflammation of branchial cyst is extremely rare. Here we present the first case of internal jugular vein thrombosis in a 54-year-old male. The patient was treated initially with antibiotics followed by excision of cyst and ligation of internal jugular vein without any complication.     

第一鳃裂囊肿及瘘管的诊断治疗

目的 探讨先天性第一鳃裂囊肿及瘘管的诊断和治疗方法。方法 回顾性分析18例患者的病例资料,全部病例行手术切除。结果 18例患者中,第一鳃裂瘘 10例,外瘘口均位于耳垂后与乳突之间,内瘘口位于外耳道,其中位于骨与软骨交界处后下壁6例;囊肿8例,其中耳垂后4例,位于下颌角2例,腮腺筋膜内2例。术后病理均确诊为鳃裂囊肿或瘘管,随访未见复发。结论 先天性第一鳃裂囊肿及瘘管临床少见,易误诊、误治;影像学检查是术前确诊的重要依据;合理的手术方案是该病治愈的关键,完整切除囊肿及瘘管是避免复发的重要措施。