Wittekindt C, Schöndorf J, Stennert E, Jungehülsing M
Department of Otorhinolaryngology, University of Cologne, Cologne, Germany.
Int J Pediatr Otorhinolaryngol. 2001 Apr 27;58(2):179-84. doi: 10.1016/s0165-5876(01)00424-4.
Malformations of the first branchial cleft are uncommon and only sporadically reported in the literature. They may present as inflammatory openings on the neck, bland cysts or fistula associated with the external auditory canal. In this retrospective study, clinical features and anatomical relationships are described in three pediatric cases. Therapeutical guidelines for surgical management of first branchial cleft anomalies are discussed.
Between 1997 and 1999 three patients aged 9 months, 2 and 7 years with first branchial cleft anomalies were included in this study. All patients were treated surgically, wide exposure and superficial parotidectomy was necessary for complete removal in two of three cases.
Exploring patients histories revealed previous infections with repeated incision and drainage procedures as well as inadequate operative resections. Clinically, purulent drainage from the ear, swelling in the parotid area and abscess formation with persistent drainage after incision in the neck or parotid area were noted.
From our case series two of three patients underwent inadequate incision and drainage procedures to combat infection followed by scar tissue formation. Because of the variable relation to the facial nerve this led to difficulties in identifying and protecting the nerve during definite surgery. Management of first branchial cleft anomalies must include the facilities to achieve ear surgery and superficial parotidectomy including facial nerve exposure.
第一鳃裂畸形并不常见，文献中仅有零星报道。它们可能表现为颈部的炎性开口、单纯囊肿或与外耳道相关的瘘管。在这项回顾性研究中，描述了三例儿科病例的临床特征和解剖关系。讨论了第一鳃裂畸形手术治疗的指导原则。
1997年至1999年间，本研究纳入了三名年龄分别为9个月、2岁和7岁的患有第一鳃裂畸形的患者。所有患者均接受了手术治疗，三例中有两例需要广泛暴露并进行浅叶腮腺切除术以彻底切除病变。
回顾患者病史发现，之前存在感染，接受过反复切开引流手术以及手术切除不彻底。临床上，观察到耳部有脓性分泌物、腮腺区肿胀以及颈部或腮腺区切开后形成脓肿且持续有分泌物排出。
在我们的病例系列中，三分之二的患者为对抗感染接受了不充分的切开引流手术，随后形成了瘢痕组织。由于与面神经的关系多变，这导致在确定性手术中识别和保护面神经存在困难。第一鳃裂畸形的治疗必须具备进行耳部手术和浅叶腮腺切除术（包括暴露面神经）的条件。
