Neonatal Presentation of an Air-Filled Neck Mass that Enlarges with Valsalva: A Case Report

Abstract

Branchial cleft cysts are common causes of congenital neck masses in the pediatric population. However, neonatal presentation of branchial cleft cysts is uncommon, but recognizable secondary to acute respiratory distress from airway compression or complications secondary to infection. We report a 1-day-old infant presenting with an air-filled neck mass that enlarged with Valsalva and was not associated with respiratory distress. The infant was found to have a third branchial cleft cyst with an internal opening into the pyriform sinus. The cyst was conservatively managed with endoscopic surgical decompression and cauterization of the tract and opening. We review the embryology of branchial cleft cysts and current management.

Keywords

branchial cleft cyst - neonate - air-filled neck mass

• References

• 1 Wilson DB. Embryonic development of the head and neck: part 2, the branchial region. Head Neck Surg 1979; 2 (1) 59-66
• 2 Agaton-Bonilla FC, Gay-Escoda C. Diagnosis and treatment of branchial cleft cysts and fistulae. A retrospective study of 183 patients. Int J Oral Maxillofac Surg 1996; 25 (6) 449-452
• 3 Doi O, Hutson JM, Myers NA, McKelvie PA. Branchial remnants: a review of 58 cases. J Pediatr Surg 1988; 23 (9) 789-792
• 4 Ford GR, Balakrishnan A, Evans JN, Bailey CM. Branchial cleft and pouch anomalies. J Laryngol Otol 1992; 106 (2) 137-143
• 5 Jacobs IN, Gray R, Wyly B. Approach to branchial pouch anomalies that cause airway obstruction during infancy. Otolaryngol Head Neck Surg 1998; 118 (5) 682-685
• 6 Morrish TN, Manning SC. Branchial anomaly in a newborn presenting as stridor. Int J Pediatr Otorhinolaryngol 1991; 21 (3) 259-262
• 7 Proctor B, Proctor C. Congenital lesions of the head and neck. Otolaryngol Clin North Am 1970; 3 (2) 221-248
• 8 Simpson RA. Lateral cervical cysts and fistulas. Laryngoscope 1969; 79 (1) 30-59
• 9 Kenealy JF, Torsiglieri Jr AJ, Tom LW. Branchial cleft anomalies: a five-year retrospective review. Trans Pa Acad Ophthalmol Otolaryngol 1990; 42: 1022-1025
• 10 Nicoucar K, Giger R, Jaecklin T, Pope Jr HG, Dulguerov P. Management of congenital third branchial arch anomalies: a systematic review. Otolaryngol Head Neck Surg 2010; 142 (1) 21-28.e2
• 11 Nicoucar K, Giger R, Pope Jr HG, Jaecklin T, Dulguerov P. Management of congenital fourth branchial arch anomalies: a review and analysis of published cases. J Pediatr Surg 2009; 44 (7) 1432-1439
• 12 Tucker HM, Skolnick ML. Fourth branchial cleft (pharyngeal pouch) remnant. Trans Am Acad Ophthalmol Otolaryngol 1973; 77 (5) ORL368-ORL371
• 13 Burge D, Middleton A. Persistent pharyngeal pouch derivatives in the neonate. J Pediatr Surg 1983; 18 (3) 230-234
• 14 Lin JN, Wang KL. Persistent third branchial apparatus. J Pediatr Surg 1991; 26 (6) 663-665
• 15 Inigués JP, Rivron A, Priou JP, Beust L, Le Clec'h G, Bourdinière J. Fistula of the 4th endo-branchial pouch. Apropos of 4 cases [in French]. Ann Otolaryngol Chir Cervicofac 1993; 110 (8) 450-454 , discussion 455
• 16 Sharma HS, Razif A, Hamzah M , et al. Fourth branchial pouch cyst: an unusual cause of neonatal stridor. Int J Pediatr Otorhinolaryngol 1996; 38 (2) 155-161
• 17 Mouri N, Muraji T, Nishijima E, Tsugawa C. Reappraisal of lateral cervical cysts in neonates: pyriform sinus cysts as an anatomy-based nomenclature. J Pediatr Surg 1998; 33 (7) 1141-1144
• 18 Nicollas R, Ducroz V, Garabédian EN, Triglia JM. Fourth branchial pouch anomalies: a study of six cases and review of the literature. Int J Pediatr Otorhinolaryngol 1998; 44 (1) 5-10
• 19 Nathan K, Bajaj Y, Jephson CG. Stridor as a presentation of fourth branchial pouch sinus. J Laryngol Otol 2012; 126 (4) 432-434
• 20 Chung EJ, Baek SK, Youn SW, Kim CH, Lee JH, Jung KY. A case of bilateral intrathyroidal branchial cleft cyst in a newborn. J Pediatr Surg 2010; 45 (1) E1-E4
• 21 Joshi MJ, Provenzano MJ, Smith RJ, Sato Y, Smoker WR. The rare third branchial cleft cyst. AJNR Am J Neuroradiol 2009; 30 (9) 1804-1806
• 22 de Buys Roessingh AS, Quintal MC, Dubois J, Bensoussan AL. Obstructive neonatal respiratory distress: infected pyriform sinus cyst. J Pediatr Surg 2008; 43 (5) E5-E8
• 23 Huang RY, Damrose EJ, Alavi S, Maceri DR, Shapiro NL. Third branchial cleft anomaly presenting as a retropharyngeal abscess. Int J Pediatr Otorhinolaryngol 2000; 54 (2-3) 167-172
• 24 Hwang TZ, Lin YJ, Tsai ST. Fourth branchial cyst presenting with neonatal respiratory distress. Ann Otol Rhinol Laryngol 2000; 109 (4) 431-434
• 25 Misawa K, Imai A, Sugiyama K, Seki A, Mineta H. A right-sided fourth branchial cleft cyst: a case report. Int J Pediatr Otorhinolaryngol 2011; 75 (3) 438-440
• 26 Rosenfeld RM, Biller HF. Fourth branchial pouch sinus: diagnosis and treatment. Otolaryngol Head Neck Surg 1991; 105 (1) 44-50
• 27 Franciosi JP, Sell LL, Conley SF, Bolender DL. Pyriform sinus malformations: a cadaveric representation. J Pediatr Surg 2002; 37 (3) 533-538
• 28 Lipsett J, Sparnon AL, Byard RW. Embryogenesis of enterocystomas-enteric duplication cysts of the tongue. Oral Surg Oral Med Oral Pathol 1993; 75 (5) 626-630
• 29 Park SW, Han MH, Sung MH , et al. Neck infection associated with pyriform sinus fistula: imaging findings. AJNR Am J Neuroradiol 2000; 21 (5) 817-822
• 30 D'Souza AR, Uppal HS, De R, Zeitoun H. Updating concepts of first branchial cleft defects: a literature review. Int J Pediatr Otorhinolaryngol 2002; 62 (2) 103-109
• 31 Haney B, Reavey D, Atchison L , et al. Magnetic resonance imaging studies without sedation in the neonatal intensive care unit: safe and efficient. J Perinat Neonatal Nurs 2010; 24 (3) 256-266
• 32 Goff CJ, Allred C, Glade RS. Current management of congenital branchial cleft cysts, sinuses, and fistulae. Curr Opin Otolaryngol Head Neck Surg 2012; 20 (6) 533-539