分支裂痕

分支裂口囊肿或窦道有哪些体征和症状？

The specific signs and symptoms of a branchial cyst or sinus tract depend upon the branchial arch or cleft of origin. As a result there are several types of branchial cleft cysts and sinus tracts.

First branchial cleft cysts and sinus tracts

First branchial cleft cysts occur just in front (of) or below the ear at the angle of the jawline. The external sinus tract opening can be above the jawline (type I) or below the jawline in the upper neck above the level of the hyoid bone (type II). If there is an internal opening, it will be inthe ear canal.

第二个分支裂口囊肿和窦道

第二个分支裂口囊肿发生在上侧颈部。外部窦道的开口将位于舌骨和甲状腺软骨之间的上颈部，仅在大颈部肌肉的前面，即胸骨骨髓肌（SCM）肌肉。如果有内部开口，它将在扁桃体区域的喉咙后部。

Third and fourth branchial cleft cysts and sinus tracts

第三和第四个分支裂口囊肿发生在下部侧颈。外部窦道开口将位于甲状腺和环状软骨下方的下侧颈部，仅在SCM肌肉前。如果有内部开口，它将在称为吡ri鼻窦区域内的喉咙内深处。

有时，第三和第四个分支异常只能有一个内部开口，没有外部开口。在这种情况下，它们可以作为甲状腺区域的颈部复发性感染。

有什么原因？

Branchial cleft cysts and sinus tracts are congenital anomalies, meaning they result from an unexpected change in the womb before birth. Although most commonly unilateral (occurring on one side of the neck), they can be bilateral (both sides of the neck). When bilateral, they can be associated with other congenital anomalies. For example, if your child has bilateral branchial cleft sinus tracts in the neck and in front of the ears (pre-auricular), they may have branchio-oto-renal (BOR) syndrome, which can be associated with hearing loss or kidney abnormalities.

如何诊断出分支裂口囊肿和窦道？

在体格检查中，很容易表明外部分支裂鼻裂道很明显。大多数在婴儿期被诊断出。使用通过外部开口放置的染料的特殊成像研究有时用于确定道的深度。

Sinus tracts with only an internal opening are much more challenging to identify. A special examination under anesthesia called endoscopy is often necessary to confirm the diagnosis.

Branchial cleft cysts are often discovered during a physical examination in a child who is showing no其他症状。家庭或医生都检测到上颈上或下颈部的肿块。

As mentioned previously, an infected branchial cleft cyst may present as a suddenly enlarging tender neck mass. Recurrent neck infections (abscesses) should raise concern of a branchial cleft cyst with an internal communication to the throat.

由于颈部可能发生各种不同的肿块，因此通常需要进行成像研究。通常，最初的研究是宫颈超声，尽管计算机断层扫描（CT）扫描或者磁共振成像（MRI）scan may be necessary for further anatomical definition of the cyst in preparation for future surgical excision.

There are other congenital cystic neck masses that can closely resemble a branchial cleft cyst. The most common is a dermoid cyst. Sometimes a dermoid cyst cannot be distinguished from a branchial cleft cyst based on the combination of the physical examination and imaging studies, and the answer is not known until the mass is removed and examined by a pathologist.

分支裂口囊肿和窦道如何处理？

The treatment for branchial cleft cysts and sinus tracts is surgical removal.

没有已知的药物疗法，除了感染的分支裂口囊肿和窦道确实需要初始抗生素治疗。应在手术前解决感染。

窦裂缝通常具有粘液状材料的排水。该材料由窦道上的腺体产生。尽管并不是真正的感染迹象，但过度排水可能会引起外科干预。

治疗需要完全手术去除囊肿，甚至可能是窦道。执行的确切过程取决于分支裂口异常的解剖位置和类型。有些操作可能非常简单，而另一些操作则非常复杂。II型第一分支裂口异常的手术去除特别具有挑战性，需要部分去除腮腺以识别和保存面神经。

并发症包括任何开放颈部手术的常见，例如血肿，血清瘤，术后感染和颈部疤痕。在特定情况下，神经无力或瘫痪也是一种风险。