title: Branchial cleft and pouch anomalies in childhood: a report of 50 surgical cases.
abstract: OBJECTIVE
  Branchial abnormalities occur when there is disturbance in the maturation of the branchial apparatus during fetal development. Branchial anomalies are congenital lesions usually present in childhood, even if they can be diagnosed later for enlargement or infection. A correct diagnosis will lead to proper management: complete surgical excision is the treatment of choice. The purpose of this article is to present clinical features, diagnostic methods and surgical treatment of branchial anomalies in childhood, based on a series of 50 patients.
  
  
  METHODS
  We conducted a retrospective analysis of a total of 50 pediatric patients operated from June 2005 to June 2014 for the presence of branchial cleft anomalies.
  
  
  RESULTS
  27 cases (54 %) presented a second branchial cleft fistula and 11 cases (22 %) a second branchial cleft cyst and one case (2 %) presented both cyst and sinus of the second branchial cleft; four cases (8 %) presented first branchial cleft cyst whereas four cases (8 %) a first branchial cleft sinus and two cases (4 %) a first branchial cleft fistula; one case (2 %) presented a piriform sinus fistula (third branchial cleft). None of our patients presented anomalies of the fourth branchial cleft. All patients underwent surgical treatment and lesions have been removed by excision or fistulectomy. No post-surgical complication occurred. The rate of recurrence was 4 %.
  
  
  CONCLUSIONS
  Pre-operative diagnosis supplies important information to the surgeon for a proper therapy: a complete excision of the lesion without inflammatory signs is essential to avoid re-intervention and to achieve a good outcome.
authors.affiliation: Department of Surgical, Medical, Pathological, Molecular and Critic Area-Chair of Pediatric Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy. c.spinelli@dc.med.unipi.it.
authors.forename: C
authors.initials: C
authors.lastname: Spinelli
authors.affiliation: Department of Surgical, Medical, Pathological, Molecular and Critic Area-Chair of Pediatric Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Rossi
authors.affiliation: Department of Surgical, Medical, Pathological, Molecular and Critic Area-Chair of Pediatric Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Strambi
authors.affiliation: Department of Surgical, Medical, Pathological, Molecular and Critic Area-Chair of Pediatric Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors.forename: J
authors.initials: J
authors.lastname: Piscioneri
authors.affiliation: Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126, Pisa, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Natale
authors.affiliation: Department of Pediatric Surgery, Children's Hospital A. Meyer, University of Florence, Via Luca Giordano 13, 50132, Florence, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bertocchini
authors.affiliation: Department of Pediatric Surgery, Children's Hospital A. Meyer, University of Florence, Via Luca Giordano 13, 50132, Florence, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Messineo
mesh_terms: D000293:Adolescent; D001934:Branchial Region / Q000002:abnormalities* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D019465:Craniofacial Abnormalities / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D005402:Fistula / Q000151:congenital / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D007223:Infant; D007558:Italy / Q000453:epidemiology; D010608:Pharyngeal Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D012189:Retrospective Studies
keywords: Branchial cleft; Children; Cyst; Fistula; Sinus; Surgery