Appropriate imaging in the management of first branchial cleft anomalies

Abstract

Background: First branchial cleft anomalies (FBCA) are rare clinical entities of the head and neck.
The low incidence and varied presentation often result in misdiagnosis and inappropriate treatment.
Correct diagnosis is essential for proper management, while an incorrect diagnosis will often lead to
inadequate treatment. A good understanding of the regional anatomy and embryology can lead to an
early diagnosis and thereby effective management of FBCA. Purpose: To present how to diagnose and
manage FBCA. Case report: A case of a 6-year-old female who had an FBCA with a history of swelling
and recurrent discharge from the fistula in the infra-auricular area. Complete excision of the tract was
performed without facial nerve complication. Clinical question: What is the appropriate imaging for
diagnosis FBCA? Review method: Scoping review was done to identify the scientific evidence about
imaging for diagnosis FBCA. Systemic searching in 4 databases (PubMed, Embase, Proquest, and Web
of Science) using keywords “first branchial cleft”, “anomaly”, and “imaging”. Result: Three article was
found relevant with the topic of imaging for diagnosis FBCA. Conclusion: Proper diagnosis of FBCA
can lead to proper management and good results. Imaging can provide an anatomical picture of each
branchial arch anomaly, which can be very helpful in preoperative planning to determine a definitive
surgical approach. Early management of FBCA can reduce the recurrence rate significantly.

Keywords: first branchial cleft, anomaly, children, imaging