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Objectives: A pyriform sinus fistula (PSF) is a rare congenital anomaly due to failed obliteration of the third or fourth pharyngeal pouch. Diagnosis and management of PSF remains controversial. We present a case of PSF and discuss its diagnosis and management. Methods: Case report and literature review. Results: A 26-year-old female with a chronic left lateral neck abscess was diagnosed with a left PSF. She underwent surgery through a combined approach to close the openings of the PSF, internally and externally. We first placed a blunted ET tube into the internal opening of the PSF. We then performed an external transcervical approach to close the PSF at the cricothyroid membrane. Briefly, after a neck debridement and washout of the chronic neck infection, we identified the recurrent laryngeal nerve (RLN) in Lore's triangle. We performed left hemithyroidectomy to facilitate the dissection and protection of the RLN to its entrance into the larynx. A flexible laryngoscope was then inserted into the left piriform sinus through the ET tube to guide external dissection by transillumination. The scar tissue attached to the superior pole of the left thyroid lobe was then ligated and divided along the cricothyroid membrane. Lastly, we cauterized the internal opening of the PSF. The patient has remained recurrence-free for 1.5 years with normal vocal cord mobility. Histopathology revealed presence of a squamous-lined tract adjacent to the thyroid tissue. Conclusions: Surgical treatment for patients with PSF should be aimed at closing the internal and external openings of the PSF, debriding chronic neck infection, and protecting the laryngeal nerves, instead of removing the entire tract. A concurrent hemithyroidectomy facilitates the identification and protection of the RLN, as well as excision of the tract. Differentiation between third and fourth branchial cleft fistulae may not be clinically necessary, as it is unlikely to alter the therapeutic plan. [ABSTRACT FROM AUTHOR]

Background: Second branchial cleft fistulae are rare pediatric anomalies managed with surgical excision and, in certain cases, ipsilateral tonsillectomy to prevent postoperative recurrence or wound infection. Limited information is available in the published literature regarding surgical techniques to maximize patient outcomes and minimize recurrence. Our objective was to describe outcomes for the largest series of branchial cleft fistulae excised using a uniform technique based on embryologic principles. Methods: We conducted a retrospective analysis of pediatric patients who underwent surgery for second branchial cleft fistula using a uniform technique developed by the senior surgeon between 2006 and 2018 at a tertiary care pediatric hospital. The technique involves dissection to the level of the greater cornu of the hyoid bone as the point of transection, which is the landmark for the base of the tonsillar fossa. Data collected included age at surgery, initial presentation, laterality of fistula tract, final pathology, and follow up data. Measured outcomes included fistula recurrence, wound infection, and other complications. Results: Of 67 patients, 28 (42%) were male and 10 (15%) had bilateral fistulae, for a total of 77 tracts excised. After a median follow up of 31 months, there were no recurrences and one wound infection that was treated successfully with oral antibiotic therapy. No patients underwent tonsillectomy. Conclusion: Effective management of second branchial cleft fistulae can be challenging. We present the largest cohort of results using a uniform surgical technique performed at a single center that obviates the need for tonsillectomy, and thus represents a less morbid and effective approach with no evidence of recurrence. [ABSTRACT FROM AUTHOR]

A dermoid cyst arising in the parotid is rare and usually represents the rare first branchial cleft type II anomaly, which can have morphology similar to a dermoid cyst. This study reports the case of a 20-year-old woman who presented with a parotid mass, which on histologic review was consistent with a dermoid cyst. This appears to be the first case report of a parotid dermoid cyst with focus on the gross and histopathologic findings and to be presented in a histopathology focused journal. The discussion includes the clinical presentation, imaging findings, gross pathology, histologic features, and differential diagnosis of parotid dermoid cysts. Although there was no prior fine needle aspiration (FNA) of the lesion in this case, parotid masses are commonly subject to FNA prior to excision. Therefore, a brief review of the FNA findings in dermoid cysts is also included. [ABSTRACT FROM AUTHOR]

A case report of bilateral pharyngoceles without a history of elevated intrapharyngeal pressures is used to support the hypothesis that pharyngoceles may be an adult manifestation of an internal branchial sinus anomaly. The development of a pharyngocele from a branchial sinus origin would suggest a predictable relationship to the hypoglossal. glossopharyngeal. and superior laryngeal nerves, which may influence the choice of surgical approach (open versus endoscopic) and the counseling of patients who are considering surgical correction. [ABSTRACT FROM AUTHOR]

Presents a series of 12 cases of first branchial cleft anomalies according to the anatomic criteria. Histology and clinical manifestations in each group; Incidences of first branchial cleft anomalies; Types of first branchial cleft anomalies; Factors necessary for early diagnosis; Comparison of the classification systems; Where accurate recognition and successful treatment of first branchial cleft anomalies depend.

Aortoenteric fistula is one of the rare complications of abdominal aortic aneurysm. The segment of intestine most frequently involved in aortoenteric fistula is the duodenum, whereas the colon is a very rare site of fistula formation. To the author's knowledge, only 13 cases have been reported in the literature to have a primary arteriocolic fistula caused by abdominal aortic aneurysm. Primary repair of the fistulization between aorta and transverse colon, resection of aneurysm, and left axillofemoral, femorofemoral bypass were performed on the patient, who represents the fourteenth case in the literature. No important complication developed and the patient was discharged from the hospital on the fifteenth postoperative day but died on the twenty-fourth postoperative day at another hospital from myocardial infarction. [ABSTRACT FROM AUTHOR]

One-third of schwannomas occur in head and neck region, mostly in the parapharyngeal region. Cystic change is seen in only 4% of schwannomas. The diagnosis of such tumors remains a challenge due to the rarity of these lesions and limited utility of fine needle aspiration cytology. When cystic, branchial cleft cyst is an important differential diagnosis more so due to radiological resemblance. We present a case of 42-year-old male with left sided neck mass masquerading as branchial cleft cyst clinically and radiologically. Multiple sections examined from the cystic areas of the mass revealed lymphoid aggregates beneath the cyst wall in addition to the schwannomatous areas. [ABSTRACT FROM AUTHOR]

Branchial cleft anomalies--which include branchial cysts, sinuses, and fistulas--are uncommon developmental defects of the neck. Approximately 2 to 3% of cases are bilateral; bilateral presentations appear to have a familial component. Only 5 cases of bilateral branchial cleft fistulas have been reported in the English-language literature, and only 1 case of simultaneous first and second branchial cleft fistulas has been previously reported. We report what to the best of our knowledge is the second case of bilateral first and second branchial cleft fistulas. [ABSTRACT FROM AUTHOR]

Presents a case report on the presence of second branchial cleft fistula in the setting of carotid artery disease. Absence of complication after the surgical treatment; Complete surgical excision as the treatment of choice for brachial cyst or sinus; Importance of antibiotics and incision prior to definitive surgery with disease infection.

Presents cases of high-output cardiac failure in renal transplant patients with large brachiocephalic arteriovenous hemodialysis fistulas. Fistula blood flow of the patients; Common complications related to surgically-created fistulas; Treatment options of the disorder.

Describes the abnormalities of the branchial cleft. Embryology; Anatomy; Case report.

Presents a case of bilateral branchial cleft cysts in a woman with a family history of bilateral branchial abnormalities. Surgical anatomy and management of branchial cleft cysts; Complete surgical excision of the fistulous tract.

Reports on a case of complete second branchial fistule presenting with a rare symptom of fetor ex ore. Results of the histologic studies of the excised fistula; Clinical significance of halitosis observed since birth.

A fourth branchial pouch sinus is a rare clinical entity. The handful of previously reported cases have all involved children. We report a rare case of an intrathyroidal fourth branchial pouch sinus in an adult. A 36-year-old man presented with a recurrent left-sided deep neck abscess. A diagnostic evaluation by barium pharyngoesophagography in conjunction with computed tomography revealed the presence of a sinus tract that extended inferiorly from the left piriform sinus to the left thyroid lobe. The synchronous use of both of these imaging modalities with shared contrast enabled us both to establish the diagnosis and formulate a successful surgical approach. The patient underwent elective neck exploration with resection of the left thyroid lobe and superior sinus tract. Postoperative pathology confirmed the presence of an epithelium-lined sinus within the left lobe of the thyroid consistent with a branchial pouch derivative. Follow-up barium pharyngoesophagography demonstrated successful closure of the sinus tract. This unique case represents a delayed clinical presentation, and it broadens the differential diagnosis of recurrent deep neck abscess and thyroid cyst in the adult. [ABSTRACT FROM AUTHOR]

Discusses the pathology of a branchial cleft cyst. Definition of the tumor; Risk associated with the infection and inflammation of the cyst; Composition of the lesion; Efficiency of surgical excision in treating the tumor.