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KMID : 0358819770040020091
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Journal of Korean Society of Plastic and Reconstructive Surgeons
1977 Volume.4 No. 2 p.91 ~ p.100
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Clinical Observations of Branchial Cysts, Sinuses and Fistulas
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卓寬哲/Tark, Kwan Chul
申晙/李英浩/柳在德/Jun, Shin/Lee, Young Ho/Lew, Jae Duck
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Abstract
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Branchial cysts, sinuses and fistulas were so named because of their supposed embryologic derivation from the branchial arches.
Although the explanation of their origin has been handed down in the literature and texts for many years, there was not a great deal of evidence to support this hypothesis. branchial cysts and sinuses have been of interest ever since they were first reported by hunczowski in 1789.
However. all discussions of the embryological origin of anomalies in the lateral neck regions were dated to the publication, in 1832, of studies by von Ascherson of all the cases of lateral cervical anomalies available at that times. His conclusion was that these lesions resulted from failure of closure or obliteration of the branchial clefts.
In 1912 Wenglowski reinvestigated and concluded that branchial cysts arose from the remnants of the thymic duct. But this theory !-as been reputed by many as untenable although Meyer agreed with him.
More recently King(1949) believed that it would be better to name these cysts according to their anatomical position or pathologic entity, such as, lateral lympho-epithelial cysts of the neck.
In 1959, Bhaskar and Bernier reviewed the histologic fee ures of 468 case and concluded that these cysts arise from epithelial inclusions in lymph nodes.
Although it is not the purpose of this paper to discuss at any great length tie possible embryologic de-elopment of branchial cysts and sinuses, believing that the long time i´s,ge of the terms "Branchial cysts and fistulas" makes chem permanent in our literature, these two conditions were considered seaerately because of significa..c differences in the history and objecti-: e findings.
Author reviewed the patients with branchial cyz;cs, sinuses and fistub s who were admitted and treated in Yonsei medical center during the period between 1965 and 1976 and evaluated clinical patterns, proper management and discussed possible embryologic origin. there have been 55 cases of branchial cysts, sinuses and fistulas in that period.
The following results were obtained:
1. Incidence was ordered as follow; preauricular sinuses, lateral cervical cysts, lateral cervical sinus group, preauricular cyst.
2. Females were affected 3 times more than males in preauricular cyst and lat eral cervical sinus group.
3. Left side was predominant in lateral cervical sinus group and bilateral involvement was overall 6%.
4. Preauricular lesions and lateral cervical sinuses were always evident at birth or just after birth. however, lateral cervical cysts were evident in 2nd and 3rd decade. The average age of onset for the lateral cervical cysts was 16.7 years.
5. Recurrence was -higher in sinus group than cyst group in 2 to 4 times.
6. The presenting symptom in most of all the preauricular sinuses was small opening on crus of helix.
7. In most cases of the lateral cervical cyst, mass was presented in the upper 1/3 of the neck along the anteromedial border of the Sternocleidomastoid muscle.
8. In most cases of the lateral cervical sinuses and complete fistulas, the cutaneous orifice was located in the lower one thirds of the neck, in reaching the pharynx, passed between the internal and external carotid artery. Internal openings were found uniformly in the region of the base of the supratonsillar fossa.
9. Usually combined with acute oro-pharyngeal infection. such as U.R.I.. tons illitis, sinusitis, caries especially in cyst group.
10. Combined congenital anomalies were cleft lip; 1 case, microtia: 1 case and accessory ear; 1 case.
11. Frequently mis-diagnosed as T.B. lymph2denitis or thyroglossal duct cyst especially in lateral cervical cysts.(47 b)
12. Management was sufficient with complete excision of fistulous openings and tracts or cysts through single skin incisicn or two transverse incisions
13. No specific complications except post-operative wound infections.
14. Microscopically the sinus tracts shot: ed lining epithelium of columnar type throughout of the major portion. the cyst wall and distal extremity o the sinus tract revealed st. squamous epithelium Lymphoid tissue y, as un iformly present beneath epithelial lining in either cvst and sinus tract.
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