engleski

BRANCHIAL CLEFT CYSTS - CLINICAL ROUTINE OR A CHALLENGE?

Introduction: Branchial cleft cysts (BC) are congenital anomalies of branchial apparatus. The differential diagnosis of tumor masses in the lateral neck region is very heterogeneous. Aim: The aim of this study was to present the cases of BC at the Department of Otolaryngology, General Hospital Zadar, over a 10-year period - from 2008 to 2018. Subjects and methods: A retrospective study was conducted on 50 subjects treated at General Hospital Zadar. Results: In 28 men and 22 women, aged 3– 95 years, six BC of the first, 42 BC of the second and two BC of the third/fourth arch were diagnosed. The average BC size was 45 mm. Based on preoperative assessment and intraoperative findings, six BCs were first, 42 second, and two third/ fourth branchial arch. In 16 patients, the formation was preoperatively inflamed and antibiotic therapy was administered. One patient underwent preoperative incision of the formation for inflammation. In five patients, the formation extended into the mediastinum. In one patient, a malignant alteration was confirmed, while one patient had bilateral BC. In 49 patients, the treatment was surgical. One patient underwent puncture and sclerotherapy of the formation. Preoperative i.v. antimicrobial therapy was performed in seven patients, and in one patient an incision. One patient underwent neck dissection. In all patients, the diagnosis was confirmed by the pathologist’s findings. We find extremely large BCs exceptionally. A 60-year-old female patient developed a painless, progressively growing swelling on the right side of the neck. Clinical examination in region II-IV determined the oval formation of elastic consistency. Extremely large BC are rare. In one 60-year-old female patient, MSCT of the neck showed formation from the level of the hyoid to the upper thoracic aperture, with compression of the central neck structures. The size of the removed formation was 150 x 80 x 65 mm. Conclusion: Although BC are primarily benign, these formations are associated with numerous intraoperative complications. A malignant transformation of the BC is also reported. In some cases, BC may be extremely large and may result in compression of the neurovascular structures of the neck.

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