First Branchial Cleft Cyst in a Child

小兒耳週邊囊腫為常見疾病，臨床上其可表現為囊腫，廔管或是膿瘍。其亦可以是由第一腮裂造成，但並不多見，僅佔所有腮裂異常的1%。就此提出一位小朋友病患，由第一腮裂囊腫造成耳後囊腫，其於本院治療之經驗分享。一名4歲女童因右耳後一腫痛之囊腫約數週，被帶至當地醫院求治。因懷疑為局部膿瘍而行手術引流，術後傷口癒合不佳而轉至本院耳鼻喉科。經檢查後，並無聽力異常或是耳道廔管，故轉至整形外科進一步傷口處理。經由手術切除後，傷口恢復良好並於數日後順利出院。病理檢查確認為第一腮裂囊腫。術後於門診追蹤情況穩定。過一年半後，其於右耳後方腫痛之腫塊復發，再次求診。經核磁共振及耳朵檢查後懷疑第一腮裂囊腫復發，再次逕行手術切除，術後傷口恢復良好並順利出院。於門診追蹤近半年無復發現象。腮裂異常是造成小朋友頭頸部異常常見原因。主要為胚胎發育時期細胞閉鎖不全造成。Work學者替第一腮裂囊腫分類成Ⅰ型和Ⅱ型。診斷上，靠病兆位置及病史，加上外耳中耳之檢查，輔助以影像學之檢查，如電腦斷層或是核磁共振，可鑑別診斷其他疾病及確立第一腮裂囊腫。由於第一腮裂囊腫可和顏面神經及腮腺緊密相連，經由術前仔細評估，可減少手術相關病態或不健全，避免傷及神經或腮線，適當完整的切除囊腫以及減少術後第一腮裂囊腫之復發。對於整形外科醫生，小朋友耳朵之第一腮裂囊腫不應該陌生。藉由小心術前診斷，耳朵和影像之檢查，整同包膜一起切除，及小心重要顏面構造保存才可達成低復發率及最佳之手術結果。

關鍵字

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並列摘要

In pediatric group, periauricular cysts occur commonly. They can exhibit as auriculobracnchial cysts, fistula or abscess clinically. Among them, origin from first branchial cleft cysts is rare and account for 1% of all branchial anomalies. They are ready to be identified in well-experience otologists or pediatric surgeons. Occasionally, plastic surgeons may meet the cases that will be mistaken as epidermoid cysts. Here, we address one to remind the situation. A 4-year-old girl was referred from local otologist to our clinic division due to persistent right posterior auricular swelling and drainage for years. No positive family or medical history was revealed except a small cyst found after her birth. Discharge became dominant in recent weeks. Over local clinic, no associated inner or middle ear anomaly was detected on examination so that surgical interventions were tried for times, which was not successfully. So, we arranged excision of first branchial cleft cyst and pathologic result confirmed the diagnosis. One and half year later, antecedent upper airway infection occurred and local condition relapsed. Image was checked and it confirmed the recurrence over previous wound site but more deepen-located. Surgical excision was performed again smoothly. Branchial anomalies are important lesions in different diagnosis of head and neck masses in children. During embryogenesis, incomplete closure of branchial cleft and pouch or failure of obliteration of cervical sinus attributes formation. Work classified first branchial anomalies into two groups by anatomy and location. Diagnosis of branchial cleft cyst will depends on clinical signs and highly suggestive the lesion location. Sometimes, the laboratory studies can be used to exclude neoplasm and infectious diseases. MRI image is important in diagnosis, which can show the extent of the lesion and its relationship to adjacent vital structures. Surgical excisions are mainstreams of therapy whether Type Ⅰ or Type Ⅱ after otologic survey. For a plastic surgeon, branchial anomalies may be a challenge disease. After otological survey and exclude some associated systemic anomalies, we will preserve vital structures and make adequate excision. It's important and can ensure pleasing outcome.

並列關鍵字

periauricular cyst ； branchial cleft cyst

國際替代計量

First Branchial Cleft Cyst in a Child

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