Philippine E-Journals

Third Branchial Cleft Anomaly with Atypical Anatomical Variation

Jose Leangelo L. Salazar | Emmanuel S. Samson | Emmanuel Tadeus S. Cruz

 

Abstract:

Objective: To report a case of a third branchial cleft anomaly with atypical anatomical variation and to present the clinical manifestations, differential diagnosis, diagnostics, management and prognosis Case: A 24-year-old female was seen in the Out Patient Department due to a painful paramedian neck mass. Physical examination showed a 2 x 2 cm firm ulcerated, non – tender, movable, well circumscribed left paramedian neck mass that does not move with tongue protrusion. Contrast enhanced CT scan showed an enhancing density in the left sternohyoid muscle coursing through the superior pole of the left thyroid gland. Video laryngoscopy was normal. The patient underwent excision of the mass with thyroid lobectomy and isthmusectomy on the left. Intraoperative finding showed a fistulous tract traversing the superior pole of the left thyroid gland, passing anterior to the internal carotid artery then lateral to the thyroid cartilage, piercing the thyrohyoid membrane terminating in the pyriform fossa. Final histopathology showed a mass consistent with an epidermal cyst with a fistulous tract. Discussion/Conclusion: Third branchial cleft anomaly although rare, should be included in the differential diagnosis of neck masses. Head and neck surgeons should be aware that third branchial cleft anomaly may present with an atypical anatomical variation such as in this case. Branchial cleft anomalies are difficult to diagnose clinically and imaging like CT scan and MRI are essential in the diagnosis. Diagnosis is confirmed intraoperatively following the direction and course of the tract and surgical excision is the treatment of choice.