Management of a prestyloid parapharyngeal first branchial cleft cyst from puncture to surgical excision and how a routine procedure can turn into an emergency

2021 ◽  
Vol 14 (1) ◽  
pp. e238727
Author(s):  
Lukas S Fiedler
Keyword(s):  
Differential Diagnosis ◽  
Parapharyngeal Space ◽  
Surgical Excision ◽  
Rare Entity ◽  
Branchial Cleft Cyst ◽  
Benign Lesions ◽  
Routine Procedure ◽  
Emergency Tracheostomy ◽  
Mri Scans ◽  
Branchial Cleft

The anatomy of the parapharyngeal space (PPS) is complex and the differential diagnosis of tumours in this area broad. Although primary tumours of the PPS account for only 0.5% of head and neck neoplasms and are benign lesions in 80% of the cases, the surgical management is crucial and needs specific planning and evaluation of CT and/or MRI scans. In literature, there are several ways to surgically deal with PPS tumours and due to location and differentiation, can reach from transparotid, submandibular transcervical and transoral approaches, extending in a mandibulotomy, further radiotherapy. Parapharyngeal cleft cysts are extremely rare and their management can be complex. We describe the presentation, the diagnosis and further management of a 71-year-old woman with a 6 cm first branchial cleft cyst in the PPS from puncture over emergency tracheostomy to elective excision via a combined transcervical/transparotid and transoral approach. We highlight the importance of the differential diagnosis and the and the correct clinical management of this rare entity.

scholarly journals Cervical thymic cyst in adult: a rare entity

2019 ◽  
Vol 5 (4) ◽  
pp. 1088
Author(s):  
Rohaizam Bin Japar Jaafar ◽  
Glen Johannes Franciscus Kemps ◽  
Ing Bing Tan ◽  
Alida Annechien Postma
Keyword(s):  
Surgical Excision ◽  
Neck Mass ◽  
Thymic Cyst ◽  
Rare Entity ◽  
Lateral Neck ◽  
Adult Onset ◽  
Branchial Cleft Cyst ◽  
Thymic Cysts ◽  
Branchial Cleft ◽  
Lateral Neck Swelling

<p>Cervical thymic cysts in adults are rare and seldom diagnosed preoperatively as it may mimic other cystic cervical swellings like a branchial cleft cyst. We present our first encounter with an adult-onset cervical thymic cyst presenting as a lateral neck mass as the sole symptom. Clinical, radiological and cytological evaluations are excellent tools to approach and assess cervical thymic cysts. Histopatholgical examination is the only mean to provide a definitive diagnosis. Adult-onset cervical thymic cyst is a rare entity but should be included in the differential diagnosis for lateral neck swelling. Surgical excision is both diagnostic and therapeutic, once malignancy has been exluded.</p>

scholarly journals First Branchial Cleft Cyst Type II

2018 ◽  
Vol 2 (2) ◽  
Keyword(s):  
Differential Diagnosis ◽  
Facial Nerve ◽  
Nerve Injury ◽  
Surgical Excision ◽  
Type Ii ◽  
Neurological Manifestations ◽  
Branchial Cleft Cyst ◽  
Branchial Cleft ◽  
The Right

Branchial cleft defects are interestingly rare and so are often not considered as a differential diagnosis. The following is an incident of the anomalie in a 20 year old Sudanese female with a swelling that was misdiagnosed and hence not treated adequately. The swelling started 2 years ago on the right parotid area with no neurological manifestations of facial nerve injury, with a cystic content that ruptured leaving a fistula behind. After MRI was done the fistula was determined, surgical excision of both the swelling and fistula was done. On follow up, no recurrence was noted.

scholarly journals Three unusual parapharyngeal space masses resected via the endoscopy-assisted transoral approach: case series and literature review

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052093606
Author(s):  
Li-Fang Shen ◽  
Ya-Lian Chen ◽  
Shui-Hong Zhou
Keyword(s):  
Parapharyngeal Space ◽  
Case Series ◽  
Transoral Approach ◽  
Carcinoma Ex Pleomorphic Adenoma ◽  
Branchial Cleft Cyst ◽  
Current Time ◽  
History Of ◽  
Cosmetic Outcomes ◽  
Branchial Cleft ◽  
The Right

Tumors of the parapharyngeal space (PPS) are rare, most originate from salivary and neurogenic tissues, and most are benign. However, there are some rarer masses in the PPS, with just a few published reports in the literature worldwide, and we may not consider them in the differential diagnosis of PPS neoplasms. We report three cases of rare masses in the PPS: Warthin’s tumor, branchial cleft cyst, and carcinoma ex pleomorphic adenoma. The three patients were admitted to our department with complaints of painless swelling in the lower side of the right face or a long history of snoring; diagnoses were confirmed histopathologically. An endoscopy-assisted transoral approach was used that allowed wide visibility for safe resection and resulted in a short hospitalization time and good functional and cosmetic outcomes. All patients have been followed to the current time, and there have been no recurrences. The transoral endoscopy-assisted approach appears to be safe, effective, and less invasive for excision of masses in the PPS.

scholarly journals Branchial Cysts in Quito, Ecuador

2020 ◽  
Vol 24 (03) ◽  
pp. e347-e350
Author(s):  
Luis Pacheco-Ojeda ◽  
Andrés Ayala-Ochoa ◽  
Karla Salvador
Keyword(s):  
General Hospital ◽  
Surgical Resection ◽  
Adult Population ◽  
Tertiary Care ◽  
Surgical Excision ◽  
Branchial Cleft Cyst ◽  
Complete Surgical Excision ◽  
Branchial Cleft ◽  
Lower Neck ◽  
Clinical Records

Introduction Branchial cleft anomalies are the second most common congenital anomaly in children. However, some lesions may not develop clinically and are not diagnosed until adulthood. The recent literature of branchial cysts (BCs) in the adult population is really scanty. For this reason, we analyzed the clinical and surgical management of the adult population treated for a BC at a tertiary care general hospital. Methods A retrospective review of the clinical records of all the patients with histological diagnosis of BC who were surgically treated at the Social Security Hospital in Quito, Ecuador, was performed. Fifty-one patients (27 women) with congenital anomalies of the 2nd (43 patients with cysts) and 3rd (6 patients with cysts and 2 with fistula) branchial arches were diagnosed and treated. Diagnosis was made on clinical grounds and by computed tomography scan. Results The 43 patients with a 2nd branchial cleft cyst underwent complete surgical excision through a wide mid-neck transverse cervicotomy. The 6 cases of 3rd branchial cleft cyst underwent surgical resection through a lower-neck transverse incision, and the 2 patients with clinical fistula in the lower aspect of the neck were operated on via an elliptical incision around this external fistula opening. Postoperative evolution was uneventful in all patients. Conclusions Branchial cysts can occasionally be diagnosed in adult patients in the setting of a general hospital population. A correct clinical and imaging assessment was diagnostic in most patients. Complete surgical resection was curative in all our patients, and postoperative complications were exceptional.

scholarly journals Branchial Cleft Cyst in the Differential Diagnosis of Recurrent Lymphadenitis

2017 ◽  
Author(s):  
Elif KILIÇ KÖNTE ◽  
Saliha KANIK YÜKSEK ◽  
Aslınur ÖZKAYA PARLAKAY ◽  
Belgin GÜLHAN ◽  
Adalet Elçin YILDIZ ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Branchial Cleft Cyst ◽  
Branchial Cleft

scholarly journals Surgical Excision of Dumbbell-shaped Vagus Nerve Schwannoma: A Case Report

2020 ◽  
Vol 19 (3) ◽  
Author(s):  
Amy O. ◽  
Kalai T. ◽  
Anusha B. ◽  
Zakinah Y
Keyword(s):  
Vagus Nerve ◽  
Parapharyngeal Space ◽  
Surgical Excision ◽  
Rare Entity ◽  
Unique Case ◽  
Transcervical Approach ◽  
Nerve Sheath ◽  
Neck Vessels ◽  
Peripheral Nerve Sheath Tumour ◽  
Left Vagus

Schwannoma is a benign peripheral nerve sheath tumour that arises from the uncontrolled proliferation of Schwann cells. Intracranial and extracranial vagus nerve schwannoma is an extremely rare entity that poses a surgical challenge due to its delicate location in the cerebrum and parapharyngeal space adjacent to major neck vessels. This report describes a unique case of a 42 years old female with left dumbbell vagus nerve schwannoma, involving both the intracranial and extracranial portion of the left vagus nerve, extending into the parapharyngeal space. She underwent a two-stage surgery in which intracranial vagus schwanomma was debulked initially, and excision of the extracranial schwanomma in the parapharyngeal space was performed in a later setting via a transcervical approach.

Radiological appearance of primary branchial cleft cyst carcinoma

1999 ◽  
Vol 113 (11) ◽  
pp. 1031-1033 ◽  
Author(s):  
Ki Hwan Hong ◽  
Woo Sung Moon ◽  
Gyung Ho Chung
Keyword(s):  
Radiation Therapy ◽  
English Literature ◽  
Radical Neck Dissection ◽  
Surgical Excision ◽  
Sufficient Evidence ◽  
Branchial Cleft Cyst ◽  
Cervical Lymph Nodes ◽  
Radiological Study ◽  
Radiological Appearance ◽  
Branchial Cleft

AbstractThe hypothesis that primary branchiogenic carcinoma originates from a branchial cleft cyst is controversial. Many reports regarding primary branchiogenic carcinoma failed to provide sufficient evidence to distinguish it from metastatic cervical lymph nodes arising from previously unrecognized primary tumours. The radiological appearance of malignant transformation from a branchial cleft cyst has not been reported previously in the English literature. A radiological study is presented that confirms the primary branchiogenic carcinoma. The management in suspected cases would be wide surgical excision of the tumour including ipsilateral radical neck dissection followed by radiation therapy.

scholarly journals Unusual Isolated Parapharyngeal Second Branchial Cleft Cyst: A Case Report and Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Emad A. Magdy ◽  
Geylan A. Fadali ◽  
Mahmoud Seif-Elnasr ◽  
Mohamed F. Fathalla
Keyword(s):  
World Literature ◽  
Parapharyngeal Space ◽  
Case Reports ◽  
Correct Diagnosis ◽  
Management Strategies ◽  
Surgical Excision ◽  
Transcervical Approach ◽  
Presenting Symptoms ◽  
Complete Surgical Excision ◽  
Branchial Cleft

Second branchial cleft cysts (BCCs) are common congenital causes of neck swellings; however, isolated parapharyngeal space presentation is extremely rare, with only sporadic cases reported. Our objectives in this report are to describe a case and review different diagnostic and management strategies adopted in the current world literature. The case presented is a 26-year-old female with a large isolated parapharyngeal BCC extending to skull base in which first presenting symptoms were referred otalgia and painful side-to-side head rotation for months followed by odynophagia. A previously ordered computed tomography (CT) scan suspected a parapharyngeal abscess. Correct diagnosis was preoperatively achieved using magnetic resonance imaging (MRI) showing a 3.1 × 3.4 × 5.4 cm parapharyngeal BCC. Cyst was completely surgically excised transoral without complications. No evidence of recurrence has been noted after 24-month follow-up. A comprehensive world literature search for all reported cases in the last 30-years revealed thirty cases in 23 separate case reports with different diagnostic and surgical modalities adopted. Presentation and management strategies in such rare cases are discussed in detail. Our study shows that although rare, BCC diagnosis should be kept in mind while dealing with isolated parapharyngeal space swellings with MRI being key for successful preoperative diagnosis. If encountered, the transoral route can be a safe, aesthetically pleasing and effective way for complete surgical excision in contrast to most other parapharyngeal swellings, which are usually better excised via a transcervical approach.

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