Purpose: To investigate the clinical manifestation of branchial cleft cyst (fistula) and provide some clinical experience on its diagnosis and treatment.
Methods: From June 1993 to December 2006, two hundred and eighty-four patients with branchial cleft cyst or fistula underwent surgical treatment were retrospectively reviewed, the preoperative examinations, preoperative diagnosis and postoperative pathological diagnosis were recorded, and the data was analyzed with SAS6.12 software package.
Results: Among the 284 patients with branchial cleft cyst or fistula confirmed by postoperative pathological diagnosis, there were 132 patients (46.5%) with first branchial cleft cyst or fistula, one hundred and forty-five patients (51.1%) with second branchial cleft cyst or fistula, and 7 patients (2.4%) with third branchial cleft cyst or fistula. First branchial cleft cyst or fistula often occurred in patients older than 40 years, second and third branchial cleft cyst or fistula often occurred in patients younger than 40 years. The pathological diagnosis confirmed 188 primary lesions, thirty-three recurrent lesions, forty-four lesions with internal fistula, fourteen lesions with secondary infection and external fistula, and three lesions with both internal and external fistulae. One patient was found with tuberculosis simultaneously, two patients with multiple cysts, one patient with venous malformation. Six lesions were found malignant, five from first branchial cleft and one from second branchial cleft. The highest accuracy of preoperative diagnosis was 66.20% using ultrasonography. During the follow-up period, 5.98% of patients had recurrence.
Conclusions: First and second branchial cleft cysts (fistula) are the most common lesions. Preoperative ultrasonography is the first choice for diagnosis of branchial cleft cyst (fistula). Complete resection including the cyst and fistula is the key to successful surgical treatment. Supported by Shanghai Leading Academic Discipline Project (Grant No.Y0203).