What is a branchial anomaly?
Branchial anomalies occur when there is a problem in the development of face and neck tissues as a baby is being formed within the womb of the mother.
The formation of the delicate face and neck structures is a complex process in the developing baby. Skin, muscles, bones and cartilage need to form around holes for the eyes, ears and mouth. If problems happen as the face and neck are forming, several things can result.
Fistulas are abnormal communications from the inside part of the face and neck onto the skin. The inside opening may be to the ear canal or throat. It usually looks like a hole on the skin of the face and neck where fluid comes out.
- Sinuses are abnormal holes on the skin that end blindly into the skin or muscle.
- Cysts are balls of tissue and tissue that are buried underneath the skin.
- Pieces of cartilage can also be found underneath the skin at abnormal places.
Large Branchial Cyst
CT Scan showing the large Branchial Cyst
Tiny external opening of Branchial Fistula on left side of Neck
Operative Photograph showing the long Fistula Tract
What are the symptoms?
Fistulas present in several locations including in front of the ear or the front part of the neck. Saliva or mucous may drain from the opening. Openings in front of the ear can connect to the ear canal. Openings through the front of the neck can connect to the throat. Fistulas can be on both sides of the neck.
Sinuses are also openings in the skin. Since there is no communication to the inside, there is no drainage usually.
Cysts are bumps that can be felt under the skin. They may be painless or have pain with swallowing. They can get larger with time.
Fistulas, sinuses and cysts may get infected and cause pain.
What are the tests?
Detailed clinical examination and history taking confirms the diagnosis. Sometimes, sonography, CT scan or MRI may be required.
What is the treatment?
Surgical removal of the cyst, sinus or fistula is the only treatment. If the anomaly is infected, infection is controlled with antibiotics prior to surgery.
What are the risks?
Bleeding, infection, damage to nearby nerves and neck structures are the possible risks.
What is the outcome?
The outcome after surgery is excellent. Once the lesion is completely excised there is no long term concern. However, a recurrence is rarely seen especially when the lesion has repeated infections before the surgery.