Abstract
Introduction:
Third and fourth branchial cleft remnants usually present as cysts, sinuses, or fistulae. In this video, we show an exceptional case of an infected large fourth branchial cleft cyst with extension into the thoracic inlet and the novel therapeutic approach that was used to provide minimally invasive management of this lesion. The total run time of the video is 4 minutes and 12 seconds.
Case Report:
A premature female twin with known antenatal diagnosis of cystic left neck mass was found to have lymphatic malformation after physical examination and postnatal ultrasonography evaluation. The lesion did not interfere with the patient's airway or breathing, and, therefore, was of limited clinical significance, and the plan was to follow it clinically and with repeat ultrasonography at the time of discharge. After administration of vaccines and development of viral upper respiratory symptoms, the patient's left neck mass enlarged significantly, prompting further investigation with an MRI, which revealed a large infected branchial cyst of type III/IV. This was treated with a combination of endoscopic electrosurgical coagulation and percutaneous drainage, with good success.
Discussion and Conclusion:
To our knowledge, this is the only example in the literature of a minimally invasive approach having been used effectively to treat a branchial sinus and cyst extending to the thoracic inlet. The patient was followed for 1 year and there was no sign of recurrence.
No competing financial interests exist and there are no conflicts of interest to disclose. All authors have approved the article and agree with its submission to Videoscopy of the Journal of Laparendoscopic and Advanced Surgical Techniques
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Runtime of video: 4 mins 12 secs
This work was presented as part of the IPEG 27th Annual Congress for Endosurgery in Children 2018, Seattle, WA.
