Second branchial cleft anomalies: Surgical management and long-term outcomes in a pediatric case series

Introduction and importance: Second branchial cleft anomalies are common congenital malformations in children, presenting as cysts, fistulas, or cervical masses. Early detection and timely management are crucial to prevent complications such as superinfection. This study evaluates the clinical presentation, surgical treatment, and longterm outcomes of second branchial cleft anomalies in pediatric patients. Case series presentation: We retrospectively reviewed 16 children treated for lateral cervical cysts and fistulas at our ENT department between January 2005 and December 2020. Of these, 10 had second branchial cleft anomalies, with a mean age of 8 years and a female predominance (80 %). Common presenting symptoms included cervical swelling, fistulas, and superinfection. Diagnostic approaches included ultrasound, CT, and auditory evoked potentials. Surgical excision of the cyst and fistula was performed in all cases. Clinical discussion: Ultrasound was the primary diagnostic tool, followed by CT for detailed anatomical assessment. Surgical excision, including complete removal of the cyst and fistula, was performed. High ligation of the fistula, rather than ipsilateral tonsillectomy, was sufficient to prevent recurrence, with no cases of recurrence observed during the follow-up period. Conclusion: Second branchial cleft anomalies in children require early diagnosis and surgical excision to avoid complications. High ligation of the fistula is an effective treatment to prevent recurrence, supporting the approach of complete excision without the need for tonsillectomy.