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Abstract
Congenital cysts and fistulas which appear on the lateral aspects of the neck are
referred to as branchial, vestigial, and lateral cervical. There is no unanimity of
opinion as to the etiology of these lesions. The work and theory of Wenglowski,4 however, have greatly influenced thought on this subject.
Several members of the same family, and of one or more generations, may be afflicted.
Other congenital lesions also are encountered occasionally in cases of lateral cervical
cysts and fistulas.
A study was made of 319 cases in which operation was performed for lateral cervical
cysts or fistulas at the Mayo Clinic. Specimens for pathologic study or data on pathologic
findings were available in all cases. Detailed microscopic studies of specimens were
made in 287 cases. Painless swelling was the most frequent symptom. In sixty-one cases
the lesions were preceded by, or associated with, infections of the upper respiratory
tract. Symptoms not infrequently appeared following tonsillectomy.
In our series patients of both sexes were affected equally. The ages of the patients
varied from 4 months to 84 years. The greatest number of patients (37 per cent) were
in the third decade. The two sides of the neck were involved approximately equally.
The lesions were bilateral in 2 per cent of the cases.
In the great majority of cases the lateral cervical cyst was located in the upper
cervical region near the angle of the jaw.
In the complete and internal fistulas the internal opening usually is in the supratonsillar
fossa. It is difficult to demonstrate clinically.
Lateral cervical cysts and fistulas must be distinguished from other lesions, especially
tuberculous lymph nodes.
These lesions have a distinct pathology and microscopic examination is essential.
The diagnosis of branchial carcinoma is probably erroneous. The lesion designated
as “branchial carcinoma” is probably secondary to a healed or undiscovered primary
lesion in the nasopharynx.
Conservative treatment is indicated in the presence of acute inflammation. Complete
excision of the cyst or fistulas is the treatment of choice in the great majority
of cases. In experienced hands the operative mortality is low.
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References
Ascherson, F. M.: Quoted by Heusinger.2
- Hals-Kiemen-Fisteln von noch nicht beobachteter Form.Virchows Arch. f. path. Anat. 1864; 29: 358-380
- On Branchial Cysts of the Neck.J. A. M. A. 1884; 3: 197-209
- Ueber die Halsfisteln und Cysten.Arch. f. klin. Chir. 1912; 98: 151-208
- Ueber die Halsfisteln und Cysten.Arch. f. klin. Chir. 1913; 100: 789-892
- The Nomenclature of Diseased States Caused by Certain Vestigial Structures in the Neck.Brit. J. Surg. 1923; 11: 131-136
- Notes on Some Congenital Anomalies Connected With the Branchial Apparatus.M. News. 1893; 63: 617-623
- The Surgical Treatment of Lateral Cervical Fistulae.Surg., Gynec. & Obst. 1924; 38: 329-335
- Branchial Anomalies and Neoplasms; a Report of Thirty-two Cases With Follow-up Results.Ann. Surg. 1928; 87: 186-209
- The Branchial Apparatus; Its Embryologic Origin and the Pathologic Changes to Which It Gives Rise, With Presentation of a Familial Group of Fistulas.Arch. Surg. 1929; 19: 410-452
- The Clinical Aspects of Branchial Cysts.Brit. J. Surg. 1923; 10: 565-572
- The Diagnosis of Branchial Cysts; With a Note Upon Its Removal.Brit. M. J. 1928; 1: 940-941
- The Clinical Aspects of Branchial Fistulae.Brit. J. Surg. 1933; 21: 173-182
- Branchial and Thyroglossal Ducts Cysts and Fistulas in Children.Surg., Gynec. & Obst. 1933; 54: 948-955
- Congenital Lesions of the Neck.J. A. M. A. 1939; 113: 1860-1864
- Ann. Surg. 1932; 95 (Quoted by Meyer, H. W.): 1-26
- Ann. Surg. 1932; 95 (Quoted by Meyer, H. W.:): 226-248
- Zur Bildungsgeschichte des Halses.Prag. med. Wchnschr. 1886; 11: 497-499
- Branchial Fistula.Arch. Otolaryng. 1933; 18: 510-515
- Branchiogenetic (Lateral) Fistulae and Cysts.in: Nelson New Looseleaf Surgery. vol. 2. Thos. Nelson & Sons, New York1937: 783-795
- Differentiation of Branchial From Other Cervical Cysts by X-ray Examination.Ann. Surg. 1931; 93: 790-792
- Validity of Present Criteria for the Diagnosis of Carotid Body Tumor (With Especial Reference to Branchiogenetic Cysts).Am. J. Surg. 1933; 22: 521-526
- A Branchial Cleft Cyst Simulating a Chronic Retro-pharyngeal Abscess.Tr. Am. Laryng. A. 1904; 26: 19-27
Fisher, G.: Quoted by Matas, Rudolph.6
- Diseases of the Branchial Apparatus; With Report of Some Cases.New York State J. Med. 1895; 61: 624-626
- Persistence of Branchial Clefts.Brit. M. J. 1899; 1: 148
- Discussion.in: Proc. Roy. Soc. Med. (Laryngological Section). 6. 1913: 36
- On Branchial Fistulae, Cysts Diverticula, and Supernumerary Auricles.J. Anat. & Physiol. 1887; 21: 289-298
- Branchial Cysts and Fistulas.J. A. M. A. 1921; 77: 26
- Cysts and Sinuses of the Neck.Cleveland Clin. Quart. 1936; 3: 311-322
- Branchial Carcinoma; Lateral Cervical Neoplasm.Surg., Gynec. & Obst. 1935; 60: 703-709
Broders, A. C.: Personal communication.
- Branchiogenic Cysts in Infancy.Surgery. 1937; 1: 792-799
- Lateral Cervical Fistula; Paraffin Injection as an Aid to Excision.S. Clin. North America. 1930; 10: 351-353
- Exstirpation der kompleten seitlichen Halsfistel mittels Extraktion des oberen Strangendes von der Mundhöhle aus.Zentralbl. f. Chir. 1897; 24: 1073-1076
Koenig, F.: Quoted by Christopher, Frederick.7
- Congenital Branchiogenic Anomalies; A Report of 82 Cases.Am. J. Surg. 1938; 39: 234-248
- Branchial Cysts.S. Clin. North America. 1920; 4: 1-7
Article info
Publication history
Received:
April 25,
1945
Footnotes
☆Abridgment of thesis submitted by Dr. Neel to the Faculty of the Graduate School of the University of Minnesota in partial fulfillment of the requirements for the degree of Master of Science in Surgery.
Identification
Copyright
© 1945 Published by Elsevier Inc.
