title: Simultaneous branchial cleft and thyroid disorders may present a management challenge.
abstract: BACKGROUND
  Cysts, sinuses or abscesses arising from second, third or fourth branchial cleft remnants may lie either within the body of, or in close proximity to the thyroid gland. Given their infrequent nature they may pose both diagnostic and management challenges for the treating surgeon when they occur in association with thyroid disorders.
  
  
  METHODS
  This is a case series. All patients with concomitant thyroid disorders and a branchial cleft anomaly treated in the University of Sydney Endocrine Surgical Unit in the 10-year period 1994-2003 comprised the study group. Patient demographics, clinical presentation, imaging, surgical management, definitive histology and outcomes were documented.
  
  
  RESULTS
  Six patients were identified with an age range of 3-76 years and a male : female ratio of 1:5. Five branchial cleft anomalies were left sided, one was right sided. Two patients had second cleft anomalies, both of which were initially thought to represent metastatic lymph nodes in association with thyroid cancer. A further two patients had third cleft abnormalities presenting as suppurative thyroiditis. The final two patients had fourth cleft abnormalities causing intraoperative management problems.
  
  
  CONCLUSIONS
  Branchial cleft remnants and anomalies are rare but may occur in association with thyroid disease. They may pose a diagnostic and management dilemma either preoperatively, when mistaken for metastatic thyroid cancer, or intraoperatively when mistaken for a thyroid nodule.
authors.affiliation: University of Sydney Endocrine Surgical Unit, Sydney, New South Wales, Australia.
authors.forename: Jane L
authors.initials: JL
authors.lastname: Harding
authors.forename: David
authors.initials: D
authors.lastname: Veivers
authors.forename: Stan B
authors.initials: SB
authors.lastname: Sidhu
authors.forename: Mark S
authors.initials: MS
authors.lastname: Sywak
authors.forename: Albert
authors.initials: A
authors.lastname: Shun
authors.forename: Leigh W
authors.initials: LW
authors.lastname: Delbridge
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001934:Branchial Region / Q000002:abnormalities*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013959:Thyroid Diseases / Q000150:complications* / Q000175:diagnosis; D013964:Thyroid Neoplasms / Q000175:diagnosis