Second branchial cyst in the parapharyngealspace - Université de ...

ANL-1153; No of Pages 4
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transcervical–transparotid approach (mandibular luxation
vs. mandibular swing, 4/36 cases) transoral approach with
total excision (5/36 cases) and marsupialisation (2/36 cases)
[5,9–15]. Simple incision, puncture-aspiration of the cyst, or
injection of sclerosant substances presents a high risk of
recurrence. Complete resection using the transcervical
approach seems to be the technique of choice but several
neurovascular complications (palsies of cranial nerves IX, X
and XII) are described [9,12]. In our experience, the key
point of the transoral approach was to aspirate the cyst –
decreasing very significantly the cyst size – before
performing the lateral dissection with a long-electrothermal
bipolar vessel sealer. For a very large cyst, even using a
transcervical approach, the reduction of the cyst size thanks
to an aspiration could be an interesting solution. Moreover,
we realized usually such aspiration for huge cervical cyst
(type 2) which allowed to decrease the incision size.
Second, the transoral approach provides the best
esthetic results. Diaz-Manzano recently described a
transoral approach allowing marsupialization with postoperative
obliteration of the tract [15]. No visible scar was
created using this transoral approach; this cosmetic
consideration could be particularly significant for our
young patients. The transparotid and transmandibular
approaches presented the poorest aesthetic results. Finally,
the transcervical approach could be preferred when the
tumor has a palpable neck component, which in practice
means that the cyst has to present a lateral cervical
extension (type 3 cyst) [3,5].
In short, parapharyngeal branchial cysts are rare and
often paucisymptomatic. The transoral approach can
provide good exposure allowing complete resection
without significant post-operative complications or cervical
scarring.
S. Saussez et al. / Auris Nasus Larynx xxx (2008) xxx–xxx
References
[1] Bailey H. The clinical aspects of branchial cysts. Br J Surg
1933;10:173–82.
[2] Proctor B. Lateral vestigial cysts and fistulas of the neck. Laryngoscope
1955;65:355–401.
[3] Maran AGD, Mackenzie J, Murray JAM. The parapharyngeal space. J
Laryngol Otol 1984;98:371–80.
[4] Güneri A, Günbay MU, Güneri EA, Ceryan K, Sütay S. Management
of parapharyngeal space cysts. J Laryngol Otol 1994;108:795–7.
[5] Shin HJ, Lee HK, Kim SY, Park HW, Khang SK, Choi CG, et al.
Parapharyngeal second branchial cyst manifesting as cranial nerve
palsies: MR findings. Am J Neuroradiol 2001;22:510–2.
[6] Carlson BM. Human embryology and developmental biology, 3rd ed.,
Mosby: St. Louis; 2004.
[7] Stevenson RE, Hall J, editors. Human malformations and related
anomalies. 2nd ed., Oxford: Oxford University Press; 2006.
[8] Wild G, Mischke D, Lobeck H, Kastenbauer E. The lateral cyst of the
neck: congenital or acquired. Acta Otolaryngol (Stockh)
1987;103:546–50.
[9] Ostfeld EJ, Wiesel JM, Rabinson S, Auslander L. Parapharyngeal
(retrostyloid)-third branchial cleft cyst. J Laryngol Otol
1991;105:790–2.
[10] Shidara K, Uruma T, Yasuoka Y, Kamei T. Two cases of nasopharyngeal
branchial cyst. J Laryngol Otol 1993;107:453–5.
[11] Thaler ER, Tom LW, Handler SD. Second branchial cleft anomalies
presenting as pharyngeal masses. Otolaryngol Head Neck Surg
1993;109:941–4.
[12] Papay FA, Kalucis C, Eliachar I, Tucker HM. Nasopharyngeal presentation
of second branchial cleft cyst. Otolaryngol Head Neck Surg
1994;110:232–4.
[13] Durrant TJ, Sevick RJ, Lauryssen C, MacRae ME. Parapharyngeal
branchial cleft cyst presenting with cranial nerve palsies. Can Assoc
Radiol J 1994;45:134–6.
[14] Chabot M, Fradet G, Thériault R, Morrissette YP. The excision of
branchial parapharyngeal cysts by transbuccal or -cervical approach. J
Otolaryngol 1995;25:108–12.
[15] Diaz-Manzano JA, Sànchez-Martinez N, Iniesta-Alcàzar J, Medina-
Banegas. A conservative surgical treatment of parapharyngeal branchial
cyst. Auris Nasus Larynx 2008;35:161–4.
Please cite this article in press as: Saussez S, et al. Second branchial cyst in the parapharyngealspace: A case report. Auris Nasus Larynx
(2008), doi:10.1016/j.anl.2008.06.005