What is Branchial Sinus, Cyst, Fistula (Branchial Pathologies)?

It is a developmental abnormality usually found on the neck above the collarbone and on the sides of the neck. It develops as a result of the tissues forming the neck and throat not growing properly during the early embryonic development period. These can open out from the neck, which we call sinus, if they do not open, they are seen as cysts in the neck. A cyst is a fluid-filled swelling. Fistula is the situation where the other end of the opening in the skin is connected to the floor of the mouth or the ear cavity. It usually occurs at birth.

Branchial cyst is a condition that begins to be seen in the womb; the neck and head area of ​​babies do not 'grow according to their nature'. Due to various genetic factors or external factors such as radiation, the limbs of the embryo in the womb do not develop as expected. This situation can also be encountered as branchial pathology.

 

 

Why Do Branchial Pathologies Occur?

Branchial clefts (the development of some anatomical structures in the neck, embryological tissues) temporarily remain as a gap and then close. If these gaps do not close, branchial pathologies occur. Approximately 37% of the masses in the lateral region of the neck are cysts, and the remaining 63% are fistulas.

Are There Types of Branchial Pathologies (Sinus, Cysts)?

Yes, there are. These are classified according to the embryological development status. During embryo development, there are 6 branchial arches, 5 branchial clefts and 5 branchial sacs on both sides of the embryo in 2-7 weeks. Different anatomical structures develop from each of these. Their locations also differ depending on the embryological structure in which they develop.

How Are Branchial Pathologies Localized?

Branchial Pathologies can most commonly consist of 4 different branchial clefts. The 1st branchial arch is located in front of or below the ear. From here, it extends to the external auditory canal following the parotid gland and facial nerve. The cyst formed in the 2nd branchial arch is located under the chin from the upper side of the neck. From here, it extends between the internal and external carotid vessels and reaches the tonsil lodge. The cyst in the 3rd branchial arch is located in the mid-lateral region of the neck, from here it extends to the pharynx and sinus region. The cyst in the 4th branchial arch is located in the lower lateral region of the neck. From here, they extend to the tip of the sinus piriformis following the carotid sheath. The most common is the 2nd branchial arch cyst. However, others can be seen rarely.

What are the Symptoms of Branchial Cysts and Sinus?

The first thing to notice is when a baby is born, a small pinhead-sized opening is seen on the sides of the neck and on the collarbone, sometimes a clear fluid like tears can come from this. If it becomes infected - which is usually seen after respiratory tract infections - swelling, redness in the neck and sometimes purulent discharge due to infection are seen. If it becomes infected, sometimes a constant ear infection is seen when it opens into the ear. If it does not become infected, it is seen as neck masses of different sizes depending on the size of the cyst.

The swellings you can see around the neck and head are the first signs of the disease. These cysts, which may seem harmless at first, can have the ability to grow on their own. This disease, which spreads throughout the body over time, often causes pain and prevents you from moving your other organs, can be extremely dangerous if it becomes infected. If it is not treated, it recurs and becomes even more difficult to remove surgically.

When Are Branchial Cysts Noticed?

Since cysts are usually small in early childhood and are not noticed if they do not become infected and attention is not paid. They usually swell and are noticed when the cyst becomes infected during an upper respiratory tract infection at an advanced age.

Cysts are diagnosed between late childhood and the age of 30. They are seen in 60% of men and 40% of women.

How are Branchial Pathologies Diagnosed?

History and physical examination are often sufficient. However, some imaging methods can be performed to reveal the anatomy. The physician who will perform the surgery should decide which examination will be performed. Neck ultrasonography, MRI and contrast fistula radiography can be performed. Will these imagings be performed, and if so, which one will be performed? The physician should decide according to the patient's physical examination findings.

Which Pathologies are Branchial Pathologies Confused with?

They are usually not confused with a good history and physical examination. However, the following pathologies should be considered; Cystig Hychroma, Hemangioma, Triglossal Cyst, Dermoid Cyst, Teratoma, Lipoma, Fibroma, Lymphadenopathy

What is the Treatment of Branchial Pathologies?

If there is an infection, it is first treated. Then it must be removed by a specialist surgeon. The vital thing to consider in the treatment is that since it is a neck pathology where vessels and nerves are widespread, care must be taken when removing it and the pathology must be completely removed, otherwise it may cause recurrences, temporary and permanent nerve damage.

What Kind of Problems Does Branchial Pathologies Cause If They Are Not Removed Surgically?

It causes constantly recurring infections, which can sometimes become systemic. It can cause lung and middle ear infections, of course the opposite is also the case. If these cysts are not removed, they may also become cancerous in later life.

What are the Surgical Operations and Possible Complications?

The risk is low when performed by experienced people. However, some temporary and permanent complications may still be seen. These are; Infection, recurrence of the pathology, bleeding, respiratory distress, and especially temporary or permanent nerve damage, especially facial paralysis.

How is Branchial Pathology Surgery Performed?

It is usually performed as an out-patient surgery. The patient's surgical preparations and examinations are performed and the surgery is performed on the same day. The patient can be discharged 4-6 hours after the surgery.

What is Done Before Surgery?

First of all, a good history should be taken and a general physical examination should be performed, and not just the neck area should be examined. Then, the family (mother and father) should be well informed about the process, that is, before the surgery, during the surgery and after. If the child is older, the child is also included in this. A number of tests are performed, these tests are not general and are determined according to the patient. The patient is also seen by the anesthesiologist, the family and the child are informed about the anesthesia process that will be experienced. The patient is left hungry for 4 hours before the surgery.

What is the Recovery Process After Surgery?

The patient is fed in accordance with the doctor and / or nurse's instructions 2 hours after the surgery. Babies over the age of 2 can be sent home after 4-6 hours. After the surgery, the patient only takes painkillers in accordance with the doctor's recommendations, there is no need to take additional medication. The patient is seen by the doctor 48-72 hours later, there is no need for dressing during this time, the stitches dissolve on their own and do not need to be removed. The patient continues his normal active life in accordance with the doctor's recommendations after the surgery.

*** The information provided here and the content of the website are designed to inform visitors, especially families. No information should be considered as advice by visitors and should not lead to any decision or action. Families should definitely have their patients examined by a pediatric surgeon, consult with him/her and make a decision based on his/her personal knowledge.