Gao Shan, Xu Qin, Yi Qinchuan
Department of Otolaryngology-Head and Neck Surgery.
Department of Oncology, Zigong Fourth People's Hospital, Zigong, PR China.
Medicine (Baltimore). 2021 Jan 22;100(3):e24375. doi: 10.1097/MD.0000000000024375.
The diagnosis of type IV branchial cleft cyst (BCC) according to the Bailey classification is very challenging due to lack of specific clinical manifestations in the early stage of the disease. Here, we present the transoral surgical route of endoscopic resection of second BCC in the parapharyngeal space (PPS) with good outcomes.
A 21-year-old man with a 1-year history of snoring complained about sore throat for 1 month and a fever that lasted for 3 days.
On admission, physical examination revealed a temperature of 39°C, pain when swallowing accompanied with a lump sensation in the throat, and inability to open mouth more than 3 cm. Blood testing revealed 19.29 × 109 white blood cells (WBCs)/L and 14.94 × 109 neutrophils/L. A cervical computed tomography (CT) examination revealed a mass with liquid density of 6.2 × 4.0 × 7.7 cm3 in the left parapharyngeal space (PPS) and pharyngeal cavity stenosis. Postoperative pathology showed the existence of lymphoepithelial cysts (left PPS), which was in accordance with the diagnosis of BCC.
The patient was administered 1.5 g ceftazidime every 12 hours, anti-inflammatory drugs, and incision drainage was performed subsequently. Then, endoscopy-assisted resection of the left PPS was performed via the transoral route. We used low-temperature plasma and an 8-Fr Foley catheter with a water capsule during the surgery.
After resection of the mass, the patient's blood results returned to within the normal range and his symptoms improved. Five days postoperatively, the incision made in the palatine arch of the pharynx opened up by 1 cm, and eventually the wound and laceration healed. Normal oral eating was restored, and no complications were observed.
Magnetic resonance imaging (MRI), and color Doppler ultrasound can be useful to diagnose BCC in PPS, which rarely occurs in the clinical setting. Extended endoscopy provides a satisfactory surgical field for trans-oral resection allowing complete resection of the BCC without serious postoperative complications.
根据贝利分类法，IV型鳃裂囊肿（BCC）的诊断极具挑战性，因为该疾病早期缺乏特异性临床表现。在此，我们介绍经口手术路径的内镜下切除咽旁间隙（PPS）内第二鳃裂囊肿，效果良好。
一名21岁男性，有1年打鼾病史，主诉咽痛1个月，发热3天。
入院时，体格检查发现体温39°C，吞咽时疼痛并伴有咽部肿块感，张口受限超过3厘米。血液检查显示白细胞（WBC）19.29×10⁹/L，中性粒细胞14.94×10⁹/L。颈部计算机断层扫描（CT）检查显示左侧咽旁间隙（PPS）有一个液体密度为6.2×4.0×7.7立方厘米的肿块，咽腔狭窄。术后病理显示存在淋巴上皮囊肿（左侧PPS），符合BCC诊断。
每12小时给患者静脉滴注1.5克头孢他啶及使用抗炎药物，随后进行切开引流。然后，经口路径行内镜辅助下左侧PPS肿物切除术。术中使用了低温等离子体和带水囊的8F Foley导管。
肿物切除后，患者血液指标恢复正常，症状改善。术后5天，咽腭弓处切口裂开1厘米，最终伤口及撕裂处愈合。恢复正常经口进食，未观察到并发症。
磁共振成像（MRI）和彩色多普勒超声有助于诊断临床罕见的咽旁间隙BCC。扩展内镜为经口切除提供了满意的手术视野，可完整切除BCC且术后无严重并发症。
