# First branchial cleft cysts in a UK paediatric tertiary centre: A 10-year single-centre case series

## TL;DR

This study examines 11 pediatric cases of first branchial cleft anomalies over 10 years, focusing on their presentation, imaging, and surgical outcomes.

## Contribution

The paper provides a detailed single-centre case series on first branchial cleft anomalies in children, highlighting clinical features and surgical outcomes.

## Key findings

- Most patients presented with persistent left-sided sinuses with purulent discharge.
- MRI was the most commonly used imaging modality for preoperative assessment.
- Surgical excision led to wound infections in 27% and transient facial nerve weakness in 18% of cases.

## Abstract

First branchial cleft anomalies are uncommon paediatric congenital lesions that may present as persistent pre-auricular or post-auricular sinuses and can involve the parotid region and facial nerve. We present a single-centre 10-year experience describing presentation, imaging, management and outcomes.

Retrospective review of a prospectively collected local dataset of paediatric patients with first branchial arch cleft cysts/tracts who underwent evaluation and surgery at a tertiary paediatric centre. Data elements included age at presentation, presenting symptoms, imaging modality, surgical treatment, postoperative complications, facial nerve dysfunction, fistula course, recurrence and follow-up.

Eleven patients were included (mean age 5.55 years, median 4 years). The commonest presentation was a persistent sinus with purulent discharge (9/11). Laterality was predominantly left-sided (8/11). MRI was the most used imaging modality (8/11). Postoperative wound infection occurred in 3/11 patients (27%); marginal mandibular branch weakness was recorded in 2/11 (both documented as transient/resolved). One patient had documented recurrence. The fistula/tract most commonly tracked from level II to the ear canal (9/11).

In this paediatric series, first branchial arch cleft anomalies most commonly presented as persistent left-sided sinuses with purulent discharge. MRI was commonly used for preoperative assessment. Surgical excision was associated with wound infection in a minority and transient marginal mandibular weakness in several cases. Larger multi-centre series with systematic prospective follow-up are needed.