Brown Lisa A, Johnston Douglas R, Rastatter Jeffrey, Sweis Brian M, Maddalozzo John
Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago, Chicago, IL, USA.
Division of Pediatric Otolaryngology Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Otolaryngology, McGaw Medical Center of Northwestern University, Chicago, IL, USA.
Int J Pediatr Otorhinolaryngol. 2019 Jul;122:161-164. doi: 10.1016/j.ijporl.2019.04.009. Epub 2019 Apr 11.
First branchial cleft anomalies (FBCAs) are rare and often misdiagnosed, which can delay proper management and increase surgical risks. Complete excision often requires parotidectomy with facial nerve dissection. The literature reports that younger patients more often have lesions deep to the nerve with higher rates of nerve injury. We hypothesized that the rate of nerve injury and complications in children with FBCAs was not different in those ≤2 years of age compared to those >2 years of age.
Retrospective review of pediatric patients who underwent resection of histopathologically confirmed FBCAs between 2007 and 2017 at a tertiary care, pediatric hospital. Presenting symptoms, lesion classification, prior procedures, imaging techniques, extent of surgery performed, facial nerve position, and complications were reviewed and compared between patients ≤2 years of age and >2 years of age at time of surgery.
43 cases of FBCAs were included in the study: 12 in the younger group and 31 in the older group. There was no difference between groups regarding the presenting symptoms, gender breakdown, lesion classification, prior procedures performed, or extent of surgery. Lesions were more commonly deep to or running between branches of the facial nerve in the younger group (33.3% vs 9.7%, p = .0496). Rates of postoperative complications and facial nerve weakness were comparable between the younger and older groups (8.3% vs 25.8%, p = .206; 25.0% vs 16.1%, p = .503). In combining the age groups, FBCAs located deep to the facial nerve had increased risk of nerve weakness postoperatively (RR 7.2) and those with a history of prior incision and drainage or resection had increased risk of postoperative complications (RR 2.36). Imaging was obtained on all subjects with accuracy rates of 80-100%.
Presenting characteristics of FBCAs in patients ≤2 years of age and >2 years of age are comparable, but lesions in younger subjects had a greater likelihood of being deep to or coursing between branches of the facial nerve. However, the rates of facial nerve injury and postoperative complications are comparable in younger and older children, owing likely to accurate preoperative imaging and appropriate surgical planning.
第一鳃裂畸形（FBCAs）较为罕见，常被误诊，这可能会延误恰当的治疗并增加手术风险。完整切除通常需要进行腮腺切除术并解剖面神经。文献报道，较年轻患者的病变更常位于神经深部，神经损伤率更高。我们推测，年龄≤2岁的FBCAs患儿与年龄>2岁的患儿相比，神经损伤和并发症的发生率并无差异。
对2007年至2017年在一家三级儿科医院接受组织病理学确诊的FBCAs切除术的儿科患者进行回顾性研究。对手术时年龄≤2岁和>2岁的患者的症状表现、病变分类、既往治疗、成像技术、手术范围、面神经位置及并发症进行回顾和比较。
本研究纳入43例FBCAs患者：较年轻组12例，较年长组31例。两组在症状表现、性别分布、病变分类、既往治疗或手术范围方面无差异。较年轻组的病变更常位于面神经分支深部或在分支之间走行（33.3%对9.7%，p = 0.0496）。较年轻组和较年长组术后并发症和面神经麻痹的发生率相当（8.3%对25.8%，p = 0.206；25.0%对16.1%，p = 0.503）。合并各年龄组后，位于面神经深部的FBCAs术后神经麻痹风险增加（相对危险度7.2），有既往切开引流或切除术史的患者术后并发症风险增加（相对危险度2.36）。所有受试者均进行了成像检查，准确率为80% - 100%。
年龄≤2岁和>2岁的FBCAs患者的表现特征具有可比性，但较年轻患者的病变更有可能位于面神经分支深部或在分支之间走行。然而，较年幼和较年长儿童的面神经损伤率和术后并发症发生率相当，这可能得益于术前准确的成像检查和恰当的手术规划。
