There were 10 females and 15 males with an age range of 18 months to 73 year with a mean age of 19 years
The majority of the patients were in their first decade of life.
the most common presentation was a lateral neck swelling.
The clinical examination showed a painless,
slowly growing tumor on the lateral surface of the neck,
more often on the right side,
and in 14 cases with a concomitant infection.
The most common malformations of the laterocervical region were cysts and fistula of the second cleft (72%) followed by those of the fourth cleft (16%).
Cyst and fistula of the first and third cleft were seen in 4% each.
Two patients had bilateral branchial fistula (8%).
One patient presented a 2nd branchial cleft cyst complicated with cellulite (4%) and another one associated with thyroid medullary carcinoma.
Imaging contribute to the right diagnosis in 76% identifying and locating exactly each abnormality except for the third branchial cyst whose imaging diagnosis was deceiving.
All patients were subject to surgical treatment.
None of the histopathological examination results showed signs of malignancy.
Most of the cysts were lined with stratified squamous epithelium.
Postoperative complications were observed in two patients,
including non compressive hematoma and secondary infection.
Fig. 1: Fistulography : Lateral view demonstrating a fistula of the First branchial cleft in a child who was complaining from recurrent neck infections. It shows the tract between the external auditory canal and sub- mandibular area
Fig. 2: Fistulography :anteroposterior view demonstrating bilateral fistula of the second branchial cleft.
Fig. 3: Fistulography: anteropostenior (A)and lateral (B) views of contrast injection of second
right brachial cleft fistula.
Fig. 4: Transverse view of the right anteriolateral aspect of the neck demonstrating a pseudo solid appearance of a second branchial cleft cyst.
Fig. 5: CT imaging from an adult presenting with left swelling of the lower course of the neck related to a type II second branchial cleft cyst. It shows the classical location along the anterior surface of the sternomastoid muscle, posterior to the submandibular gland and external to the carotid arteries.
Fig. 6: Axial CT image showing a left-sided infected lesion in relation to the thyroid gland.The abnormality was confirmed to be an infected fourth branchial cleft cyst in a 54-year-old man who had a history of recurrent infections at the antero-lateral course of the neck.
Fig. 7: US: Longitudinal view of an anechoic fourth Branchial cleft cyst with posterior enhancement.
Fig. 8: Transverse ultrasound (US) image from the child confirming the presence of a thick-walled cystic structure that was confirmed to be an infected fourth branchial cleft cyst.
Fig. 9: Fistulography: anteropostenior (A)and lateral (B) views of contrast injection of Third
left brachial cleft fistula which is arising from the piriform sinus