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LETTER TO EDITOR
Year : 2011  |  Volume : 3  |  Issue : 2  |  Page : 136-137  

Type 2 first branchial cleft cyst presenting as childhood deafness


Department of Pathology, P E S Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India

Date of Web Publication31-Oct-2011

Correspondence Address:
Anikode Subramanian Ramaswamy
Department of Pathology, P E S Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2727.86856

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How to cite this article:
Bylappa S, Ramaswamy AS, Manjunatha HK, ArunKumar SP. Type 2 first branchial cleft cyst presenting as childhood deafness. J Lab Physicians 2011;3:136-7

How to cite this URL:
Bylappa S, Ramaswamy AS, Manjunatha HK, ArunKumar SP. Type 2 first branchial cleft cyst presenting as childhood deafness. J Lab Physicians [serial online] 2011 [cited 2019 Sep 21];3:136-7. Available from: http://www.jlponline.org/text.asp?2011/3/2/136/86856

Sir,

Childhood deafness is commonly attributed to entities like genetic (40%) and non-genetic (19%) causes like infections. Forty-one percent have no ascribed etiology. [1] A 14-year-boy presented with childhood deafness in the left ear. On examination of the left ear, conductive deafness and obliteration of the external auditory canal (EAC) was noted. The computed tomography scan showed features of EAC atresia. Microscopy of the sample obtained from canaloplasty showed components of ectodermal and mesodermal elements. Stratified squamous lining epithelium, folliculosebaceous units, ceruminous glands, fibrocartilagenous tissue [Figure 1]a, lymph node tissue [Figure 1]b and few skeletal muscle fibers were seen.
Figure 1: Cyst wall composed of skin, adnexal structures, ceruminous glands, cartilage (a) and lymphoid follicle formation along with salivary gland tissue (b) Hematoxylin and eosin; ×10

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First branchial cleft anomalies are due to incomplete closure of the cleft. Obliteration of the cleft proceeds from ventral to dorsal and, hence, is commonly located in the Poncent's triangle, which is limited by EAC above, mental region anteriorly and hyoid bone inferiorly. [2] Type 1 anomalies present as a cystic mass and are purely ectodermal. It contains squamous epithelial structures and no adnexal structures, while type 2 anomalies present as a cyst, sinus or fistula or any combination and are of ectodermal and mesodermal in origin containing squamous epithelium, adnexal structures or cartilage. Presence of lymph node indicates recurrent infection. [3],[4],[5]

Clinical differential diagnosis includes parotid tumor, Hodgkin disease, lymphoma, tuberculosis and parotitis. [2] Microscopically, lymphoepithelial cyst is a differential diagnosis. But, the presence of mesodermal components favors type 2 cyst. [4]

In our case, the lesion recurred obliterating the EAC and there was no recovery from conductive deafness. Type 2 cysts are known to recur if the surgical excision is incomplete. Definitive treatment is complete excision with wide exposure, and sometimes requiring parotidectomy and exposure of the facial nerve. [5] Early diagnosis and proper treatment are needed to avoid recurrent infection and secondary development of fistulous tract.

 
   References Top

1.Davis A. Epidemiology of hearing impairment. In: Ludman H, Wright T, editors. Diseases of the ear. 6 th ed. London: Arnold publishers; 1998. p. 133-4.  Back to cited text no. 1
    
2.Chen MF, Ueng SH, Jung SM, Chen YL, Chang KP. A type II first branchial cleft cyst masquerading as an infected parotid Warthin's tumor. Chang Gung Med J 2006;29:435-9.  Back to cited text no. 2
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3.Barnes L. The Ear. In: Silverberg SG, De Lellis RA, Frable WJ, Livolsi VA, Wick MR, editors. Silverberg's Principles and Practice of Surgical Pathology and Cytopathology. 4 th ed. Philadelphia: Churchill Livingstone Elsevier; 2006. p. 2270-1.  Back to cited text no. 3
    
4.Koeller KK, Alamo L, Adair CF, Smirniotopoulos JG. Congenital cystic masses of neck. Radiologic-pathologic correlation. Radiographics 1999;19:121-46.  Back to cited text no. 4
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5.Triglia JM, Nicollas R, Ducroz V, Koltai PJ, Garabedian EN. First branchial cleft anomalies: a study of 39 cases and a review of the literature. Arch Otolaryngol Head Neck Surg 1998;124:291-5.  Back to cited text no. 5
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