ABSTRACT
RATIONALE: The diagnosis of type IV branchial cleft cyst (BCC) according to the Bailey classification is very challenging due to lack of specific clinical manifestations in the early stage of the disease. Here, we present the transoral surgical route of endoscopic resection of second BCC in the parapharyngeal space (PPS) with good outcomes. PATIENT CONCERNS: A 21-year-old man with a 1-year history of snoring complained about sore throat for 1âmonth and a fever that lasted for 3âdays. DIAGNOSES: On admission, physical examination revealed a temperature of 39°C, pain when swallowing accompanied with a lump sensation in the throat, and inability to open mouth more than 3âcm. Blood testing revealed 19.29â×â109 white blood cells (WBCs)/L and 14.94â×â109âneutrophils/L. A cervical computed tomography (CT) examination revealed a mass with liquid density of 6.2â×â4.0â×â7.7âcm3 in the left parapharyngeal space (PPS) and pharyngeal cavity stenosis. Postoperative pathology showed the existence of lymphoepithelial cysts (left PPS), which was in accordance with the diagnosis of BCC. INTERVENTIONS: The patient was administered 1.5âg ceftazidime every 12âhours, anti-inflammatory drugs, and incision drainage was performed subsequently. Then, endoscopy-assisted resection of the left PPS was performed via the transoral route. We used low-temperature plasma and an 8-Fr Foley catheter with a water capsule during the surgery. OUTCOMES: After resection of the mass, the patient's blood results returned to within the normal range and his symptoms improved. Five days postoperatively, the incision made in the palatine arch of the pharynx opened up by 1âcm, and eventually the wound and laceration healed. Normal oral eating was restored, and no complications were observed. LESSONS: Magnetic resonance imaging (MRI), and color Doppler ultrasound can be useful to diagnose BCC in PPS, which rarely occurs in the clinical setting. Extended endoscopy provides a satisfactory surgical field for trans-oral resection allowing complete resection of the BCC without serious postoperative complications.