Sclerotherapy for Benign Cystic Lesions of the Head and Neck: Systematic Review of 474 Cases.

OBJECTIVE: The role of sclerotherapy for vascular lesions of the head and neck is well established. However, the efficacy of sclerotherapy for benign cystic lesions of the head and neck is less clear. The objective of this review is to determine the efficacy and safety of sclerotherapy for benign cystic lesions of the head and neck. DATA SOURCES: PubMed/MEDLINE, Cochrane Library, and Embase. REVIEW METHODS: The PRISMA guidelines (Preferred Reporting Systems for Systematic Reviews and Meta-analyses) were followed for this systematic review. Studies of patients with benign head and neck cystic masses treated primarily with sclerotherapy were included. Thirty-two studies met criteria for inclusion. RESULTS: A total of 474 cases of sclerotherapy were reviewed. Agents comprised OK-432, ethanol, doxycycline, tetracycline, and bleomycin. Lesions in the analysis were ranula, thyroglossal duct cyst, branchial cleft cyst, benign lymphoepithelial cyst, parotid cyst, thoracic duct cyst, and unspecified lateral neck cyst. A total of 287 patients (60.5%) had a complete response; 132 (27.9%) had a partial response; and 55 (11.6%) had no response. OK-432 was the most widely utilized agent, with a higher rate of complete response than that of ethanol (62.0% vs 39.4%, P = .015). Fifty-three cases (11.2%) required further surgical management. One case of laryngeal edema was reported and managed nonoperatively. CONCLUSION: Sclerotherapy appears to be a safe and efficacious option for benign cystic lesions if malignancy is reliably excluded. Efficacy rates are comparable to those of sclerotherapy for vascular malformations. The rate of serious complications is low, with 1 incident of airway edema reported in the literature.

You're the Flight Surgeon.

Milner MR. You're the flight surgeon: an unusual case of pharyngitis. Aerosp Med Hum Perform. 2017; 88(4):439-442.

Fine needle aspiration cytology versus frozen section in branchial cleft cysts.

BACKGROUND: Branchial cleft cysts occur because of a failure of involution of the second branchial cleft. However, as well-differentiated squamous cell carcinoma can mimic branchial cleft cysts, there is a lack of consensus on the appropriate management of cystic neck lumps. OBJECTIVE: To report our experience of fine needle aspiration cytology and frozen section examination in the management of cystic neck lumps. METHOD: Retrospective case note review of patients managed in the Southern General Hospital, Scotland, UK. RESULTS: The sensitivity of fine needle aspiration cytology and frozen section for detecting branchial cleft cysts was 75 per cent and 100 per cent respectively. Two patients who did not undergo intra-operative frozen section examination were either over- or under-treated, which is discussed. CONCLUSION: Adult patients subjected to surgical excision of a suspected branchial cyst should undergo intra-operative frozen section analysis regardless of clinical suspicion for malignancy. This part of management is critical to ensure patients are offered appropriate treatment.

Congenital anomalies presenting as recurrent post-auricular abscesses: an institution based retrospective study.

OBJECTIVES: This report is intended to bring out the association of recurrent postauricular abscess in children with various underlying congenital anomalies. MATERIALS AND METHODS: A retrospective study was done in tertiary care setting from the year August 2005 to February 2012 using the medical record department database to retrieve the patient details. During this study period, a total of 215 children with an age range of 1-14 years were treated at the hospital with postauricular abscess. We analysed the data using appropriate statistical tests for parametric and nonparametric data and setting the p value at 0.05 for significance. For testing the association between the recurrence of abscess and the presence of underlying congenital anomalies, Fischer's t test was used. RESULTS: A total of 215 patients were studied, of which 41 patients presented with recurrence. 26 of the 41 patients (63.4%) had recurrent postauricular abscess with associated congenital anomalies. Among the 26 patients, in 16 patients (62%), the recurrent abscesses were due to postauricular sinuses. Other less common causes were infected post auricular dermoid cyst, first branchial cysts, collaural fistula and congenital aural atresia. There was a statistically significant association of the recurrence of abscess with presence of underlying congenital anomalies. CONCLUSION: Paediatric recurrent postauricular abscesses are rare in the post antibiotic era. Their presence should alert a treating physician of an underlying congenital anomaly.

Treatment of a branchial sinus tract by sclerotherapy.

A 16-year-old female presented with a sinus on the skin just medial to the right clavicle, which had discharged clear fluid on a daily basis for a number of years. A sinogram was performed and showed a long sinus tract extending from the region of the right clavicle to the lateral pharyngeal wall. Surgical treatment would have required an extensive procedure and seemed inappropriate in view of the relatively mild symptoms the patient was experiencing. Instead sclerotherapy was used to induce healing of the lesion. This was performed using 3% sodium tetradecyl sulphate foam delivered via a catheter along the entire length of the tract. There were no immediate complications from this procedure and on review at 1 and 6 weeks post-procedure the patient reported a significant improvement in the fluid discharge. At 1 year post-procedure this improvement had been sustained. The patient did report an occasional discharge from the sinus tract orifice at the base of her neck, but she did not feel that this was a significant problem and declined any further treatment.

Quiste branquial tipo I: presentación de un caso / A type-I brachial cyst: a case report

Se presenta el caso de una adolescente de 14 años de edad, raza blanca, del sexo femenino, con antecedentes de salud relativa, que se valoró en la consulta externa del Policlínico Universitario Ernesto Guevara de la Serna de Sandino, Pinar del Río, Cuba. La paciente presentó un cuadro caracterizado por el aumento de volumen superficial de la región lateral derecha superior del cuello, por debajo de la rama horizontal de la mandíbula y por delante del borde anterior del músculo esternocleidomastoideo, cerca del pabellón auricular y la parótida, de aproximadamente 4 cm. de diámetro, móvil, no doloroso, de superficie lisa y consistencia renitente, sin cambios en la coloración de la piel; al examen físico otorrinolaringológico no se encontraron otras alteraciones, posteriormente se realizó un ultrasonido en esa región. El diagnóstico dio como resultado un quiste branquial y se procedió a la exéresis quirúrgica por el equipo de autores del artículo, realizándose estudio anatomopatológico. Los autores presentan las experiencias derivadas de la atención del caso, y revisan la literatura médica sobre el tema con especial referencia al diagnóstico y tratamiento...(AU)

A Caucasian 14 year-old female adolescent having relative health history was assessed at Ernesto Guevara de la Serna Outpatient Clinic in Sandino, Pinar del Rio, Cuba. The patient presented a clinical chart which was characterized by an increase of the superficial volume of the right upper lateral region of neck, below the horizontal branch of the mandible and to the front of the anterior border of sternocleidomastoid muscle, near outer ear and parotid having approximately 4cm of diameter, motile, painless, smooth surface and renitent consistency, without changes in skin color; physical and ENT examinations found no other alterations, subsequently a sonographic study in that region confirmed a brachial cyst that was surgically removed performing pathological studies. The authors presented the experiences derived from this case and the medical literature about the topic was reviewed emphasizing on the diagnosis and treatment...(AU)

Sclerotherapy of branchial cleft cysts using OK-432.

OBJECTIVES: OK-432 has been widely used to treat lymphangioma and ranula; however, there are few studies for its use in treatment of branchial cleft cyst (BCC). We conducted this study to evaluate the effectiveness of sclerotherapy using OK-432 in treatment of BCC. STUDY DESIGN AND SETTING: Case series with planned data collection. SUBJECTS AND METHODS: From 2004 to 2007, we treated 23 patients with BCC using OK-432 sclerotherapy. Of these 23 patients, 18 had unilocular cysts and five had multilocular cysts. The sizes of the BCCs were measured and compared before and after treatment. RESULTS: Of the 23 cases, 14 (60.8%) showed complete regression; all of these were unilocular cysts. Of the remaining individuals with unilocular cysts, only one patient failed to show any response. This individual subsequently underwent surgical excision. A total of five patients with multilocular cysts showed no or partial response and subsequently underwent surgical excision. Minor adverse effects including fever and local pain were reported by 13 (56.5%) patients. CONCLUSION: These results suggest that sclerotherapy using OK-432 is an effective and safe treatment modality for BCC, especially for unilocular cysts. Sclerosing of unilocular BCC with OK-432 should therefore be considered before surgical excision.

The therapeutic effect of OK-432 (picibanil) sclerotherapy for benign neck cysts.

BACKGROUND AND OBJECTIVES: In general, benign neck cysts are treated by surgical excision. This can present technical difficulties and frequent recurrences, because of insufficient surgery. Sclerosing agents such as OK-432 have been tested for the nonsurgical treatment of these cysts. We have assessed the efficacy of OK-432 sclerotherapy for benign neck cysts. MATERIALS AND METHODS: The study group consisted of 75 patients (42 men, 33 women) diagnosed with and treated for benign neck cysts between March 2001 and December 2007 by intralesional injection of OK-432. The liquid content of each cyst was aspirated as much as possible, and the same volume of OK-432 solution was injected. Patients were assessed by ultrasonography or computerized tomography, and therapeutic outcomes and adverse effects were evaluated by patient age, sex, cyst type, and number of injections. RESULTS: Of the 75 treated patients, 31 (41.3%) showed total shrinkage, seven (9.3%) showed near-total shrinkage (>90% of cyst volume), five (6.6%) showed marked shrinkage (>70% of cyst volume), and 17 (22.7%) showed partial shrinkage (<70% of cyst volume). No response was seen in 15 patients (20%). Despite repeated sclerotherapy, eight patients (10.7%) showed recurrences. Minor adverse effects of therapy included fever, localized pain, and odynophagia but these complications spontaneously disappeared within several days. CONCLUSIONS: OK-432 sclerotherapy is a safe and effective primary alternative to surgery in patients with benign neck cysts.

Squamous carcinoma arising in a branchial cleft cyst: have you ever treated one? Will you?

The existence of primary branchiogenic carcinoma - that is, carcinoma arising in a pre-existing branchial cleft cyst (a benign developmental cyst) - has in recent decades been the subject of increasing scepticism. Recognition of the propensity of a variety of head and neck sites - including in particular the tonsil - to give rise to cervical metastases while the primary tumours themselves remain undetected has given rise to the idea that virtually all cystic carcinomas of the neck represent metastatic deposits, whether or not their primary sites are found. A diagnosis of primary branchiogenic carcinoma should be viewed with extreme scepticism, and every effort should be made (e.g. imaging, panendoscopy, elective tonsillectomy) to exclude the existence of a primary site elsewhere, before considering a diagnosis of primary branchiogenic carcinoma.

Treatment of branchial cleft cyst with intracystic injection of OK-432.

CONCLUSIONS: The data suggest that branchial cleft cyst (BCC) can be primarily treated with OK-432 sclerotherapy and only the remaining lesions with excision. OBJECTIVES: To evaluate the effectiveness of sclerotherapy using OK-432 in the treatment of BCC. MATERIALS AND METHODS: We treated 12 BCC patients (3 males and 9 females; mean age 25 years) with OK-432 sclerotherapy at an outpatient clinic. The cystic fluids were aspirated and diagnosed by cytomorphology and DNA cytometric analysis to exclude malignancy. The fluid aspirated from the cyst was replaced with an equal volume of OK-432 solution. The sizes of cysts were measured and compared before and after injection. The remaining cysts were excised and histopathologically compared with the excised BCCs that had not been treated with OK-432. RESULTS: Seven of 12 patients (58%) showed a complete response after OK-432 injection, administered one to three times. Three patients (25%) had only partial response and two (17%) were stationary. Five patients with remaining lesions underwent excision. There was no difficulty in dissecting around the cysts and no increased morbidity during operation. None of the patients had evidence of recurrences or malignancies developing during the follow-up period (mean 21 months, range 17-26 months). There were no major side effects except fever after sclerotherapy.

Post-operative adjuvant chemoradiotherapy with carboplatin and 5-fluorouracil for primary branchiogenic carcinoma.

BACKGROUND: Branchiogenic carcinoma occurs only rarely. A pathologic description and post-operative adjuvant therapy with carboplatin (CBDCA) and daily oral 5-fluorouracil (UFT) are analysed. CASE REPORT: We present the case of a 52-year-old man with a lateral neck mass lesion. A fine-needle aspiration was performed and cytological examination showed class IV disease. The patient underwent excision of the mass and an intra-operative rapid pathological diagnosis of squamous cell carcinoma was made; we then went on to perform neck dissection. The patient received post-operative radiation therapy (total 64 Gy) and chemotherapy (CBDCA 100 mg/week and UFT 300 mg/day). He was followed up for 62 months after surgery without any evidence of recurrence of cancer. CONCLUSION: This case satisfies the histological criteria established by Martin and Khafif for a primary branchiogenic carcinoma. The management would be wide surgical excision of the tumour, including neck dissection, followed by adjuvant therapy, such as chemoradiation. As post-operative adjuvant therapy for primary branchiogenic carcinoma, chemoradiotherapy with carboplatin and UFT was a safe and well tolerated regimen.

Lumps and bumps in neonates and infants.

There are many developmental abnormalities that may appear in the neonate and in infants when critical steps in embryogenesis fail. These steps are often not fatal but can lead to significant morbidity for those patients affected. A logical approach is needed in addressing both the diagnostic and therapeutic issues that arise when caring for these patients, as various lesions will warrant an observational approach, and others may require imaging studies or definitive surgical intervention. Additionally, there are other "lumps and bumps" that are seen in the neonatal and infantile age groups that include malignancies and cutaneous neoplasms with associated systemic sequelae.

Quiste branquial / Brachial cyst

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Pearls and pitfalls in the management of branchial cyst.

INTRODUCTION: Although branchial cysts may present as asymptomatic swellings, about one-third present acutely due to inflammation. The use of fine-needle aspiration biopsy (FNAB) and computerized tomography (CT) is controversial. The treatment of inflamed cysts is also controversial. AIMS: To compare the findings of FNAB and CT between cases of branchial cysts presenting as an asymptomatic swelling, and those presenting acutely due to inflammation, and to examine the management of infected cysts. MATERIALS AND METHODS: Retrospective review of the medical records of 39 adult patients with histologically proven branchial cysts treated by the senior author (C.V.T.) between 1994 and 2003. RESULTS: Twenty-eight patients presented with an asymptomatic swelling. Eleven presented acutely with inflammation. A higher incidence of indeterminate fine needle aspirates and atypical CT features were found in the inflamed group. Initial treatment in the infected group consisted of intravenous antibiotics, followed by aspiration or surgical exploration in non-resolving cases. Interval excision after six weeks was performed in all inflamed cases without complication. CONCLUSIONS: FNAB is recommended in all cystic neck lumps to rule out malignancy, but may be inconclusive, especially in inflamed cysts. Inflamed cysts are best treated with intravenous antibiotics, with or without aspiration or incision and drainage, followed by interval excision.

[A case report: anomaly of the fourth branchial pouch with recurring cervical abscesses. Cauterization with trichloroacetic acid closed the fistula opening and cured the patient]. / Fallbeskrivning: anomali i fjärde gälfickan med recidiverande halsabscesser. Etsning med triklorättiksyra tillslöt fistelmynning och botade patienten.

A fourth branchial pouch sinus is a rare congenital anomaly, which in a 13-year-old girl presented clinically as recurrent deep cervical abscesses. The location of the majority of these anomalies is the left side of the neck (90%). Radiological and endoscopic investigations verified the diagnosis. The internal orifice located at the apex of the pyriform sinus could facilitate contamination by infectious pharyngeal secretions and lead to abscess recurrence. Traditionally, the recommended treatment is radical surgery. It can, however, be technically difficult to excise the whole fistula tract. In this patient we used a non-invasive treatment modality; chemocauterization with 40% trichloroacetic acid (TCA). After three treatments the fistula was closed. To date (month no. 15) there has been no abscess recurrence. TCA chemocauterization seems to be a safe first-line treatment for patients with pyriform sinus fistulas.

Marsupialization and iodine sclerotherapy of a branchial cyst in a horse.

A 6-month-old Morgan colt was evaluated because of a 10-cm right-sided retropharyngeal swelling. The swelling was soft and moveable on examination, and palpation did not elicit signs of pain. Radiography revealed a large space-occupying mass ventral to the second cervical vertebra; ultrasonography revealed an anechoic fluid-filled structure with a well-defined hyperechoic capsule. Fine-needle aspiration yielded a viscous amber fluid. Cytologic evaluation indicated that the fluid was an exudate; anaerobic and aerobic bacterial culture did not yield any growth. Histologic examination of a portion of the cyst capsule revealed a connective tissue wall lined by pseudostratified columnar to cuboidal epithelium, consistent with a branchial cyst. The cyst wall was marsupialized to the skin, and iodine sclerotherapy was performed twice daily for 14 days, at which time forceps were introduced into the cyst and the cyst lining was removed. The site was allowed to heal by second intention, but 10 days later, the swelling recurred. An incision was made over the previous marsupialization site, and residual remnants of the cauterized cyst lining were removed with a forceps. The foal did not have any other complications during the subsequent 2 years. Branchial arch cysts are uncommon embryonic anomalies of horses, mice, cats, dogs, and cattle. Results suggest that marsupialization and iodine sclerotherapy may be a viable alternative to surgical excision in horses with branchial cysts; however, the entire cyst lining must be removed at the completion of sclerotherapy to prevent recurrence and abscess formation.