WordNet

an abnormal passage leading from a suppurating cavity to the body surface (同)sinus
of or relating to gills (or to parts of the body derived from embryonic gills)

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瘻(ろう)菅(長い菅状になった潰瘍)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/02/27 23:22:38」(JST)

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A branchial cleft cyst is a congenital epithelial cyst that arises on the lateral part of the neck usually due to failure of obliteration of the second branchial cleft (or failure of fusion of the second and third branchial arches) in embryonic development. Less commonly, the cysts can develop from the first, third, or fourth clefts.

Symptoms

Most branchial cleft fistulae are asymptomatic, but they may become infected. The cyst, however, usually presents as a smooth, slowly enlarging lateral neck mass that may increase in size after an upper respiratory tract infection.^[1]

Pathophysiology

Branchial cleft cysts are remnants of embryonic development and result from a failure of obliteration of one of the branchial clefts, which are homologous to the structures in fish that develop into gills.^[2]^[3]

Pathology

The cyst wall is composed of either squamous or columnar cells with lymphoid infiltrate, often with prominent germinal centers. The cyst may contain granular and keratinaceous cellular debris. Cholesterol crystals may be found in the fluid extracted from a branchial cyst.

Diagnosis

Types

Bilateral branchial cleft sinuses during surgery.

Four branchial clefts (also called "grooves") form during the development of a human embryo. The first cleft normally develops into the external auditory canal,^[4] but the remaining three arches are obliterated and have no persistent structures in normal development. Persistence or abnormal formation of these four clefts can all result in branchial cleft cysts which may or may not drain via sinus tracts.

First branchial cleft cysts are rare (less than 1%)^[5] and typically originate in the angle of the mandible and extend to the external auditory canal. They are often associated with the facial nerve.
Second branchial cleft cysts account for a majority of branchial cleft cysts and can be found along the anterior border of the Sternocleidomastoid muscle. If sinus tracts are present, they typically drain into the tonsillar fossa, found between the palatoglossal arch and the palatopharyngeal arch.^[5]
Third and fourth branchial cleft cysts are rare. They are located about 2/3 of the way down the SCM anteriorly, usually lower than second branchial cleft cysts. Sinus tracts, if present, ascend along the carotid sheath posteriorly to the internal carotid artery, under the glossopharyngeal nerve, and over the vagus nerve and hypoglossal nerve to open into the piriform sinus or thyrohyoid membrane.^[5]

Treatment

Conservative (i.e. no treatment), or surgical excision. With surgical excision, recurrence is common, usually due to incomplete excision. Often, the tracts of the cyst will pass near important structures, such as the internal jugular vein, carotid artery, or facial nerve, making complete excision impractical.^[6]

References

^ Colman, Rebecca (2008). Toronto Notes. pp. OT33.
^ Hong, Chih-ho. Branchial cleft cyst. eMedicine.com. URL: http://www.emedicine.com/derm/topic61.htm. Accessed on: August 24, 2008.
^ Shubin, Neil "Your Inner Fish" 2009
^ "Duke Embryology - Craniofacial Development". web.duke.edu. Retrieved 2016-09-08.
^ ^a ^b ^c "Differential diagnosis of a neck mass". www.uptodate.com. Retrieved 2016-09-08.
^ Waldhausen JH (May 2006). "Branchial cleft and arch anomalies in children". Seminars in pediatric surgery. 15 (2): 64–9. doi:10.1053/j.sempedsurg.2006.02.002. PMID 16616308.

External links

Cervical Cysts, Sinuses, and other Neck Lesions
Pictures and Imaging of Branchial Cleft Cysts
Additional Images of Branchial Cleft Cysts

UpToDate Contents

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English Journal

Congenital cutaneous fistula at the sternoclavicular joint - Not a dermoid fistula but the remnant of the fourth branchial (pharyngeal) cleft ?

Ohno M1, Kanamori Y2, Tomonaga K1, Yamashita T1, Migita M1, Takezoe T1, Watanabe T1, Fuchimoto Y1, Matsuoka K3.
International journal of pediatric otorhinolaryngology.Int J Pediatr Otorhinolaryngol.2015 Sep 30. pii: S0165-5876(15)00472-3. doi: 10.1016/j.ijporl.2015.09.025. [Epub ahead of print]
OBJECTIVES: A fourth branchial pouch remnant is well known as a pyriform sinus fistula. However, there has been no report of a fistula composed of the complete remnant of the fourth branchial apparatus. We experienced patients with a congenital lower neck cutaneous fistula which was thought to be th
PMID 26453273

Branchial cleft and pouch anomalies in childhood: a report of 50 surgical cases.

Spinelli C1, Rossi L2, Strambi S3, Piscioneri J4, Natale G5, Bertocchini A6, Messineo A7.
Journal of endocrinological investigation.J Endocrinol Invest.2015 Sep 24. [Epub ahead of print]
BACKGROUND AND AIMS: 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 dia
PMID 26403983

Surgery versus endoscopic cauterization in patients with third or fourth branchial pouch sinuses: A systematic review.

Derks LS1, Veenstra HJ1, Oomen KP1, Speleman L1, Stegeman I1,2.
The Laryngoscope.Laryngoscope.2015 Sep 15. doi: 10.1002/lary.25321. [Epub ahead of print]
OBJECTIVES: To systematically review the current literature on treatment of third and fourth branchial pouch sinuses with endoscopic cauterization, including chemocauterization and electrocauterization, in comparison to surgical treatment.DATA SOURCES: PubMed, Embase, and the Cochrane Library.REVIEW
PMID 26372400

Japanese Journal

第2鰓溝の遺残による内瘻孔が原因であった扁桃周囲および深頸部膿瘍の1例

小町太郎,三枝英人,山口智 [他],門園修,中村毅,粉川隆行,愛野威一郎,木村繁,伊藤裕之
日本気管食道科学会会報 66(1), 40-45, 2015
症例は66歳男性。3日前から左側咽頭痛が出現し，急激に悪化した。左側頸部の発赤・腫脹が出現し，経口摂取も不能となったため当科へ緊急入院した。初診時，左側頸部の発赤・腫脹が顎下部から鎖骨上まで及んでいた。また，左側扁桃下極後下方付近の発赤・腫脹，左側咽頭側壁から喉頭蓋，披裂喉頭蓋襞に浮腫性変化を認めた。頸部造影CTでは左側扁桃後下方付近から副咽頭間隙，咽頭後間隙，前頸間隙に膿瘍の形成を認めたため，緊 …
NAID 130004915941

右側下咽頭梨状陥凹瘻孔の1例

平澤一浩,塚原清彰,中村一博 [他],本橋玲,上田百合,遠藤稔,佐藤宏樹,鈴木衞
日本気管食道科学会会報 65(6), 481-484, 2014
下咽頭梨状陥凹瘻は第4䚡弓の発生の左右差により生じるが，多くは左側である。今回われわれは，比較的稀な右側の下咽頭梨状陥凹瘻を経験したので報告する。症例は8歳の男児で，主訴は右頸部痛および発熱。造影CTでは，甲状腺右葉とその周囲に低吸収域が認められた。急性甲状腺炎と診断され，抗菌薬による治療を行った。下咽頭食道造影を3度行い，右側の下咽頭梨状陥凹瘻が認められ，全身麻酔で手術を行った。直達鏡にて右下咽 …
NAID 130004724637

A Case of Branchio-oto-renal Syndrome

Masui Takashi,Yane Katsunari,Nakai Yoshinori,Ota Ichiro,Hosoi Hiroshi
耳鼻咽喉科臨床　補冊 140(0), 108-109, 2014
… Branchio-oto-renal (BOR) syndrome is an autosomal dominant disorder with branchial anomalies: ear malformation, hearing loss, cervical fistula, and renal anomalies.We experienced a case of BOR syndrome. … A 16-year-old female had bilateral preauricular pits, bilateral hearing loss, left cervical fistula, and right renal aplasia. … We treated left cervical fistula only in this case. …
NAID 130004707409

Related Pictures

★リンクテーブル★

リンク元	「鰓瘻」
関連記事	「branchia」「branchial」

「鰓瘻」

Branchial arch fistula
	Fistulography of a right branchial cleft sinus.
Classification and external resources
Specialty	medical genetics
ICD-10	Q18.0 (ILDS Q18.020)
OMIM	113600
DiseasesDB	1588
MedlinePlus	001396
eMedicine	derm/61 radio/107
	[edit on Wikidata]