Shinn Justin R, Purcell Patricia L, Horn David L, Sie Kathleen C Y, Manning Scott C
Department of Otolaryngology, University of Washington, Seattle, Washington, USA.
Department of Otolaryngology, University of Washington, Seattle, Washington, USA
Otolaryngol Head Neck Surg. 2015 Mar;152(3):506-12. doi: 10.1177/0194599814562773. Epub 2014 Dec 18.
This study describes the presentation of first branchial cleft anomalies and compares outcomes of first branchial cleft with other branchial cleft anomalies with attention to otologic findings.
Case series with chart review.
Pediatric tertiary care facility.
Surgical databases were queried to identify children with branchial cleft anomalies. Descriptive analysis defined sample characteristics. Risk estimates were calculated using Fisher's exact test.
Queries identified 126 subjects: 27 (21.4%) had first branchial cleft anomalies, 80 (63.4%) had second, and 19 (15.1%) had third or fourth. Children with first anomalies often presented with otologic complications, including otorrhea (22.2%), otitis media (25.9%), and cholesteatoma (14.8%). Of 80 children with second branchial cleft anomalies, only 3 (3.8%) had otitis. Compared with children with second anomalies, children with first anomalies had a greater risk of requiring primary incision and drainage: 16 (59.3%) vs 2 (2.5%) (relative risk [RR], 3.5; 95% confidence interval [CI], 2.4-5; P<.0001). They were more likely to have persistent disease after primary excision: 7 (25.9%) vs 2 (2.5%) (RR, 3; 95% CI, 1.9-5; P=.0025). They were more likely to undergo additional surgery: 8 (29.6%) vs 3 (11.1%) (RR, 2.9; 95% CI, 1.8-4.7; P=.0025). Of 7 persistent first anomalies, 6 (85.7%) were medial to the facial nerve, and 4 (57.1%) required ear-specific surgery for management.
Children with first branchial cleft anomalies often present with otologic complaints. They are at increased risk of persistent disease, particularly if anomalies lie medial to the facial nerve. They may require ear-specific surgery such as tympanoplasty.
本研究描述第一鳃裂畸形的表现，并比较第一鳃裂畸形与其他鳃裂畸形的治疗结果，同时关注耳科检查结果。
病例系列研究并进行图表回顾。
儿科三级护理机构。
查询手术数据库以确定患有鳃裂畸形的儿童。进行描述性分析以确定样本特征。使用Fisher精确检验计算风险估计值。
查询共识别出126名受试者：27名（21.4%）患有第一鳃裂畸形，80名（63.4%）患有第二鳃裂畸形，19名（15.1%）患有第三或第四鳃裂畸形。患有第一鳃裂畸形的儿童常出现耳科并发症，包括耳漏（22.2%）、中耳炎（25.9%）和胆脂瘤（14.8%）。在80名患有第二鳃裂畸形的儿童中，只有3名（3.8%）患有中耳炎。与患有第二鳃裂畸形的儿童相比，患有第一鳃裂畸形的儿童需要进行初次切开引流的风险更高：16名（59.3%）对2名（2.5%）（相对风险[RR]，3.5；95%置信区间[CI]，2.4 - 5；P <.0001）。他们在初次切除后更有可能出现疾病持续存在的情况：7名（25.9%）对2名（2.5%）（RR，3；95% CI，1.9 - 5；P =.0025）。他们更有可能接受额外的手术：8名（29.6%）对3名（11.1%）（RR，2.9；95% CI，1.8 - 4.7；P =.0025）。在7例持续存在的第一鳃裂畸形中，6例（85.7%）位于面神经内侧，4例（57.1%）需要针对耳部的手术进行治疗。
患有第一鳃裂畸形的儿童常出现耳部相关症状。他们出现疾病持续存在的风险增加，尤其是当畸形位于面神经内侧时。他们可能需要进行如鼓室成形术等针对耳部的手术。
