Newer concepts of first branchial cleft defects

• Walter P. Work

抄録

Duplication embryological anomalies of the first branchial cleft are reported. Six cases are presented which were treated since 1963. A classification of these cases is suggested wherein there are Type I and Type II lesions. Type I is of ectodermal origin and is considered a duplication of the membranous external auditory canal. Initial infection and subsequent infection often necessitate repeated incision and drainage. Only one of the five cases of Type I did not show infection. Characteristically, these lesions occur medial to the concha and frequently extend to the postauricular crease. They pass anterior and deep to the ear lobe, superior to the facial nerve, parallel to normal external auditory canal and finally end in a cul‐de‐sac on a bony plate at the level of the mesotympanum. Microscopically, these lesions are cystic, have a squamous epithelium lining, form keratin and may or may not show accessory skin structures. Surgical excision is the treatment of choice. The surgery must be performed during remission from infection and consists mainly of parotid gland and facial nerve dissections. After the lesion is excised, the normal membranous external auditory canal is incised lengthwise, and an iodoform pack is placed in the area of the excised anomaly and brought out externally through the recently incised membranous external auditory canal and the meatus. During the first few days postoperatively, the pack is gradually removed and the bed of the wound repacked if necessary. Such a technique enhances wound healing. Type II are duplication anomalies of the membranous external auditory canal and pinna; they contain skin (ectoderm )and cartilage (mesoderm). These anomalies likewise are usually diagnosed after infection has taken place and after incision and drainage of an abscess at a point below the angle of the mandible. The upward extension of this lesion passes over the angle or horizontal ramus of the mandible. It continues upward passing either lateral or medial to the facial nerve and in rare instances may split its main trunk. It may end inferior to the membranous external auditory canal or form a sinus in that location. The middle ear is normal. Only one case with such anomaly is reported here, but in 1963, Work and Proctor reported five of six cases as Type II anomalies. Wide surgical excision is curative. The facial nerve must be preserved intact. Types I and II anomalies are not associated with pretragal cysts or sinuses.

収録刊行物

• The Laryngoscope

  The Laryngoscope 82 (9), 1581-1593, 1972-09

  Wiley

キーワード

• Otorhinolaryngology

詳細情報

• CRID: 1361981469489245952
• NII論文ID: 30009422692
• DOI: 10.1288/00005537-197209000-00001
• ISSN: 15314995
• ISSN: 0023852X
• Web Site: https://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1288%2F00005537-197209000-00001
• Web Site: https://onlinelibrary.wiley.com/doi/pdf/10.1288/00005537-197209000-00001
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