Coexistence of Bilateral First and Second Branchial Cleft Anomalies: A Rare Case Report
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CLINICAL REPORT
Coexistence of Bilateral First and Second Branchial Cleft Anomalies: A Rare Case Report Saloni Shah1
•
Divya Prabhat1 • Minnie Bodhanwala2
Received: 6 August 2020 / Accepted: 26 August 2020 Ó Association of Otolaryngologists of India 2020
Abstract The simultaneous presence of bilateral second branchial arch anomalies along with bilateral first arch anomalies is extremely rare, with only four such cases reported in the literature. We are presenting fifth classic case of bilateral preauricular sinuses with bilateral branchial sinuses in 1.5 year old girl child with no similar family history. Keywords Bilateral preauricular sinuses Bilateral branchial sinuses Fifth case 1.5 year girl Microscopic excision
Introduction Branchial cleft anomalies include branchial cysts, sinuses, and fistulas are typically seen in the paediatric population. They are usually unilateral [1, 2]. Bilateral anomalies occur in 2–3% of all cases; The rate of bilateralism is higher in familial cases [3]. We searched the literature on this rare presentation and found only four such cases [4–6]. We are presenting fifth such case and as per best of our knowledge, first case in such a small child.
Case Presentation A 1.5 year old female child presented to our OPD few months back with c/o persistent discharging sinuses of 0.1 9 0.1 cm in size present on both sides of her neck and 0.1 9 0.1 cm size sinuses both sides in front of her ears. Parents noted these discharging sinuses since birth and took local treatment to control infection but there was no complete cure. Patient had no similar family history, no fetal or maternal complications during birth, no H/o prenatal drug intake. Child’s vaccination was complete till date. All routine blood investigations were normal. Paediatric reference was given to rule out cardiac (2D ECHO) and renal abnormalities (USG Abdomen) as a part of brachio-oto-renal syndrome which came normal. Patient’s BERA test was done to rule out hearing defect as a part of brachio-otic syndrome which also came normal. Both branchial sinuses were of Type 2—sinus tract opens in front of sternocleidomastoid muscle, posterior to submandibular gland and lateral to carotid sheath diagnosed on sinogram.
Treatment
& Saloni Shah [email protected] 1
E.N.T Department, B.J.Wadia Hospital for Children, Acharya Donde Marg, Parel East, Mumbai 400012, India
2
E.N.T Department, B.J.Wadia Hospital for Children and Nawrosjee Wadia Maternity Hospital, Mumbai 400012, India
Surgical excision of all four sinus tracts done precisely by using microscope. The sinus openings on neck cannulated with 2-0 Nylon suture. Elliptical incision was taken around sinus opening. The tract was blindly ending at tonsillar fossa. We also used methylene blue dye in diluted form intra op to guide the tract. Both the sinus tracts were excised in toto. On left side we found Branchial cleft cyst with the sinus tracts. Surgical closure done with 4-0 vicryl.
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Indian J Otolaryngol Head Neck Surg Fig. 1 Excision of Preauricular sinus
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