Branchial cleft anomalies

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Branchial cleft anomalies comprise of a spectrum of congenital defects that occur in the head and neck.

Pathology

The anomalies result from branchial ~~apparati~~apparatus (six arches; five clefts), which are the embryologic precursors of the earand the muscles, blood vessels, bones, cartilage, and mucosallining of the face, neck, and pharynx ¹.

During the 3^rd to 5^th week of embryonic development, the second arch grows caudally and covers the third, fourth and sixth arches. When it fuses to the skin caudal to these arches, the cervical sinus is formed. Eventually, the edges of cervical sinus fuse and the ectoderm within the tube disappears ⁹. Persistence of branchial cleft or pouch results in a cervical anomaly located along the anterior border of the sternocleidomastoid muscle from the tragus of the ear to the clavicle ¹⁰.

The range of anomalies can include:

cyst: no internal or external communication
fistula: communicates both internally and externally
sinus: incomplete tract

Cysts are the most common, outnumbering fistulas and sinuses ~2:1 ⁶. Among fistulae and sinuses, the order prevalence is thought to be: external draining sinus > complete fistula > internal draining sinus ⁶; although some anomalies can occur in combination.

The ~~complete~~full list of branchial anomalies includes:

first branchial cleft anomalies (5-8%) ^1-8
second branchial cleft anomalies (commonest by far: 90-95%) ⁸
third branchial cleft anomalies (rare)
fourth branchial cleft anomalies (rare)
the fifth cleft does not give rise to the cervical sinus of His which is part of the reason that there are no fifth branchial cleft anomalies

The 3^rd and 4^th branchial arches tend to be very close and therefore the distinction between these two cleft anomalies can be difficult on imaging ^7-8.

-Branchial cleft anomalies comprise of a spectrum of congenital defects that occur in the head and neck.<h4>Pathology</h4>The anomalies result from <a href="/articles/branchial-apparati">branchial apparati</a> (six arches; five clefts), which are the embryologic precursors of the ear and the muscles, blood vessels, bones, cartilage, and mucosal lining of the face, neck, and pharynx 1.During the 3rd to 5th week of embryonic development, the second arch grows caudally and covers the third, fourth and sixth arches. When it fuses to the skin caudal to these arches the cervical sinus is formed. Eventually the edges of cervical sinus fuse and the ectoderm within the tube disappears 9. Persistence of branchial cleft or pouch results in a cervical anomaly located along the anterior border of the sternocleidomastoid muscle from the tragus of the ear to the clavicle 10.The range of anomalies can include:<ul>
+Branchial cleft anomalies comprise of a spectrum of congenital defects that occur in the head and neck.<h4>Pathology</h4>The anomalies result from <a href="/articles/branchial-apparati">branchial apparatus</a> (six arches; five clefts), which are the embryologic precursors of the ear and the muscles, blood vessels, bones, cartilage, and mucosal lining of the face, neck, and pharynx 1.During the 3rd to 5th week of embryonic development, the second arch grows caudally and covers the third, fourth and sixth arches. When it fuses to the skin caudal to these arches, the cervical sinus is formed. Eventually, the edges of cervical sinus fuse and the ectoderm within the tube disappears 9. Persistence of branchial cleft or pouch results in a cervical anomaly located along the anterior border of the sternocleidomastoid muscle from the tragus of the ear to the clavicle 10.The range of anomalies can include:<ul>
-</ul>Cysts are the most common, outnumbering fistulas and sinuses ~2:1 6. Among fistulae and sinuses the order prevalence is thought to be: external draining sinus > complete fistula > internal draining sinus 6; although some anomalies can occur in combination.The complete list of branchial anomalies includes<ul>
+</ul>Cysts are the most common, outnumbering fistulas and sinuses ~2:1 6. Among fistulae and sinuses, the order prevalence is thought to be: external draining sinus > complete fistula > internal draining sinus 6; although some anomalies can occur in combination.The full list of branchial anomalies includes:<ul>

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Branchial cleft anomalies

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