Branchial Remnants: A Retrospective Study of 50 Patients and Review of the Literature

Objectives: To study the clinical spectrum of branchial remnants and to analyze the methods of diagnosis and management of these lesions. Methods: Retrospective review of 50 patients presenting with 60 branchial remnants reported at Jordan University Hospital from 1986 – 2001. Results: Fifty patients (23 males, 27 females) presented with 60 branchial remnants were identified. Of these, 23 on the right side, 22 on the left side, 5 bilaterally and 1 patient with 4 anomalies. Thirty one patients presented with branchial cysts, 12 cervical sinus, 10 fistulas and 3 patients with dual branchial remnants; cyst and sinus and one patient with branchial cartilage. Sixty eight percent of branchial cysts occurred below the age of 20 years whereas 76% percent of fistulas and sinuses occurred below the age of 10 years. The junction of the upper and middle third of sternocleidomastoid muscle was the most common site for branchial cyst (96%) and in one case the cyst was found inside the parotid gland. Two patients with branchial sinus had recurrence ranging between 1- 3 times and another 2 patients with fistulas had 3 times recurrence. Conclusions: Branchial remnants have a variety of clinical presentations; cyst, fistula and sinus. Accurate diagnosis is crucial in preventing recurrences and redoes surgeries. Good history and physical examination is enough in the diagnosis of most of these lesions. Preoperative radiological diagnosis preferably a computed tomography (CT scan) is helpful in determining the extent, nature and possible complications of these anomalies. Complete and careful surgical excision is recommended in all types of branchial remnants.