Surgical treatment of first branchial cleft anomalies using retrograde facial nerve dissection technique

TL;DR

This study evaluates a new surgical technique for removing first branchial cleft anomalies that reduces facial nerve damage and recurrence.

Contribution

The retrograde facial nerve dissection technique is introduced as a novel approach to improve FBCA surgery outcomes.

Findings

Complete resection was achieved in all 19 patients without facial nerve palsy.

No recurrence was observed during a median follow-up of 23.9 months.

Postoperative pain and paresthesia improved, though cosmetic satisfaction was limited.

Abstract

First branchial cleft anomalies (FBCAs) are infrequent congenital malformations. In FBCAs removal surgery, due to the previous infection history and the anatomical proximity of the FBCAs tract to the facial nerve, postoperative recurrence and facial paralysis are not uncommon. This study aimed to assess the clinical feasibility and outcomes of FBCAs resection using the retrograde facial nerve dissection technique.

This retrospective study included 19 patients (mean age, 6.3 ± 4.4 years) who underwent FBCAs excision via retrograde facial nerve dissection between 2017 and 2023. Data on demographics, operative details, histopathology, postoperative complications, and follow-up survey were reviewed.

Preoperative infection history was present in 94.7% of patients; 42.1% had prior incision and drainage and 15.8% had previous excision attempts. Complete resection was achieved in all cases without facial nerve palsy. No recurrence was observed during the follow-up periods (median, 23.9 ± 9.8 months). Postoperative pain and paresthesia showed clinical improvement, while cosmetic satisfaction was relatively limited.

In FBCAs patients, the close proximity of the facial nerve and the adhesion between the tract and facial nerve pose significant challenges. Using retrograde facial nerve dissection is believed to enable complete removal and reduce postoperative facial nerve paralysis.

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