Midline cervical cleft: a case report

A 14-year-old boy presented with complaints of a sinus in the middle of neck, with mucoid discharge present since birth. MRI sinogram along with MRI neck was taken which revealed a sinus tract opening in midline, extending posteriorly and traversing inferiorly to end blindly above sternum. Patient was planned for an elective excision of sinus tract, with z-plasty for decreased scarring. Congenital midline cervical cleft is a rare entity that was first described in 1924. Subsequently there have been fewer than 100 cases reported in medical literature. It typically manifests at birth as a cleft at level of suprasternal notch with a pseudonipple above it. Pathogenesis of congenital midline cervical clefts remains speculative. Differential diagnosis includes thyroglossal duct cysts or branchial cleft anomalies.

Download Full-text

Neck cysts, sinuses, thyroglossal duct cysts, and branchial cleft anomalies

Operative Techniques in General Surgery ◽

10.1053/j.optechgensurg.2004.10.010 ◽

2004 ◽

Vol 6 (4) ◽

pp. 281-295 ◽

Cited By ~ 4

Author(s):

Christopher R. Moir

Keyword(s):

Thyroglossal Duct ◽

Branchial Cleft Anomalies ◽

Thyroglossal Duct Cysts ◽

Branchial Cleft

Download Full-text

Fourth Branchial Anomaly Presenting with a Lateral Neck Mass in a Neonate

Journal of Neonatal Surgery ◽

10.47338/jns.v3.98 ◽

2014 ◽

Vol 3 (3) ◽

Cited By ~ 1

Author(s):

Tae-Kyung Yoo ◽

Soo-Hong Kim ◽

Hyun-Young Kim ◽

Kwi-Won Park

Keyword(s):

Differential Diagnosis ◽

Neck Mass ◽

Lateral Neck ◽

The Third ◽

Neck Masses ◽

Important Differential Diagnosis ◽

Branchial Cleft Anomalies ◽

Uncommon Case ◽

Branchial Cleft ◽

Branchial Anomalies

Branchial cleft anomalies are an important differential diagnosis in congenital neck masses in infants. The third and fourth branchial anomalies are rare branchial cleft anomalies, which are hard to differentiate. We report here an uncommon case of the fourth branchial anomaly that was presented as an asymptomatic neck mass in a neonate.

Download Full-text

Thyroglossal duct cyst masquerading as a haematoma

The Journal of Laryngology & Otology ◽

10.1258/002221504322928071 ◽

2004 ◽

Vol 118 (3) ◽

pp. 240-241 ◽

Cited By ~ 9

Author(s):

Ricardo Persaud ◽

Melissa Short ◽

Prasad Kothari ◽

Anthony Robinson

Keyword(s):

Needle Aspiration ◽

Thyroglossal Duct Cyst ◽

Thyroglossal Cyst ◽

Suprasternal Notch ◽

Aspiration Cytology ◽

En Bloc ◽

Duct Cyst ◽

Thyroglossal Duct ◽

Thyroglossal Duct Cysts ◽

Needle Aspiration Cytology

Thyroglossal duct cysts most frequently present in childhood as painless midline swellings around the level of the hyoid. Classically the cyst moves upwards on protruding the tongue. Here we report a novel case of a thyroglossal cyst in an adult in whom the history, examination and fine needle aspiration cytology were typical of a traumatic haematoma. This case is also unique because the thyroglossal duct cyst extended beyond the thyroid gland to the suprasternal notch and actually required two parallel transverse cervical incisions for its complete en bloc removal.

Download Full-text

Congenital Midline Cervical Cleft: A Case Report with Review of Literature

International Journal of Head and Neck Surgery ◽

10.5005/jp-journals-10001-1301 ◽

2017 ◽

Vol 8 (1) ◽

pp. 25-30 ◽

Cited By ~ 1

Author(s):

Ashwin A Jaiswal ◽

Bikram K Behera ◽

Ravindranath Membally ◽

Manoj K Mohanty

Keyword(s):

Case Report ◽

Cleft Lip ◽

Classical Case ◽

Review Of Literature ◽

Suprasternal Notch ◽

Anterior Neck ◽

Thyroglossal Duct Cysts ◽

Bronchogenic Cysts ◽

Head Neck ◽

Midline Cervical Cleft

ABSTRACT Aim To highlight a rare case of a congenital midline cervical cleft (CMCC) in context with embryological theories/hypothesis, presentation, and management along with review of literature. Introduction Congenital midline cervical cleft is a rare but interesting anterior neck anomaly with controversial theories/ hypothesis regarding its embryogenesis. Case report We describe here a classical case of midline cervical cleft that presented at birth with a cephalocaudal orientation, extending from the level below the hyoid bone to the suprasternal notch with a length of 3 cm and width of 0.5 cm. At 6 months of age, the lesion was excised and closure was done by multiple Z-plasty, with satisfactory results. Discussion Although the diagnosis is clinical, it is frequently misdiagnosed. The associated clinical features could include thyroglossal duct cysts, cleft lip/mandible/sternum, cervical contractures, mandibular spurs, microgenia, and/or bronchogenic cysts. If it is not treated at an early age, it can result in complications like webbing of the neck, dental malocclusion, and restricted neck movements. Conclusion Earliest recognition of CMCC and proper intervention can provide better esthetic and functional prognosis. Clinical significance A correct earlier recognition of the lesion and appropriate surgical management are key to avoid longterm complications. How to cite this article Jaiswal AA, Behera BK, Membally R, Mohanty MK. Congenital Midline Cervical Cleft: A Case Report with Review of Literature. Int J Head Neck Surg 2017;8(1):25-30.

Download Full-text

Midline Cervical Cleft: A Rare Congenital Anomaly

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348941011901107 ◽

2010 ◽

Vol 119 (11) ◽

pp. 786-790

Author(s):

Gayathri Mandya Renukaswamy ◽

Marlene A. Soma ◽

Benjamin E. J. Hartley

Keyword(s):

Congenital Anomaly ◽

Differential Diagnosis ◽

Surgical Excision ◽

Soft Tissue Defect ◽

Suprasternal Notch ◽

Anterior Neck ◽

Street Hospital ◽

Rare Congenital Anomaly ◽

Great Ormond Street Hospital ◽

Midline Cervical Cleft

Objectives: A midline cervical cleft (MCC) is a rare congenital anomaly due to failure of fusion of the first and second branchial arches during embryogenesis. It may present as a midline defect of the anterior neck skin with a skin projection or sinus, or as a subcutaneous fibrous cord. This report evaluates the clinical features and surgical management of an MCC. Methods: We analyzed a series of 4 patients with an MCC successfully treated at Great Ormond Street Hospital for Children in London. Results: Three male patients and 1 female patient between 4 and 11 months of age were found to have an MCC. Each patient presented with an erythematous, fibrous band of tissue extending between the chin and the suprasternal notch. Treatment comprised surgical excision of the lesion and Z-plasty repair. We present the embryology, common clinical presentation, investigations, differential diagnosis, and histology, along with a literature review, of this uncommon malformation of the anterior neck. Conclusions: An MCC is a differential diagnosis to consider when assessing a child with a midline cervical lesion. Early surgical excision with Z-plasty repair of the soft tissue defect is the treatment of choice to prevent long-term complications.

Download Full-text

Surgery for thyroglossal duct and branchial cleft anomalies

The American Journal of Surgery ◽

10.1016/0002-9610(78)90292-1 ◽

1978 ◽

Vol 136 (3) ◽

pp. 348-353 ◽

Cited By ~ 46

Author(s):

Stephen A. Deane ◽

Robert L. Telander

Keyword(s):

Thyroglossal Duct ◽

Branchial Cleft Anomalies ◽

Branchial Cleft

Download Full-text

Midline Cervical Cleft

PEDIATRICS ◽

10.1542/peds.92.2.286 ◽

1993 ◽

Vol 92 (2) ◽

pp. 286-287

Author(s):

JOHN MADDALOZZO ◽

ANDREW FRANKEL ◽

LAUREN D. HOLINGER

Keyword(s):

Primary Care ◽

Care Physician ◽

Thyroglossal Duct Cyst ◽

Developmental Abnormality ◽

Initial Examination ◽

Duct Cyst ◽

Thyroglossal Duct ◽

Branchial Cleft ◽

Midline Cervical Cleft ◽

Midline Cleft

The congenital midline cervical cleft represents a rare developmental abnormality that is not widely reported in the pediatric literature.1 Usually the lesion is initially evaluated by a pediatrician or other primary care physician who misinterprets the deficit as a branchial cleft deformity or thyroglossal duct cyst. Although developmentally related to these disorders, the congenital midline cleft represents a distinct anomaly that should be recognized at initial examination. The parents can then be appropriately counseled about the implications and further management decisions that are peculiar to this disorder. We have recently treated five cases of congenital midline cervical cleft at the Children's Memorial Hospital, Chicago, IL.

Download Full-text

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

BMJ Case Reports ◽

10.1136/bcr-2020-238727 ◽

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.

Download Full-text