Branchial anomalies occur when there is a problem in the development of face and neck tissues as a baby is being formed within the womb of the mother. The formation of the face and neck structures is complicated in the developing baby. Skin, muscles, bones and cartilage need to form around holes for the eyes, ears and mouth. If problems happen as the face and neck are forming, several things can result.
If the structure is infected, the infection must be treated first with antibiotics. Sometimes, control of the infection requires draining the pus from underneath the skin.
Surgical removal of the cyst, fistula or sinus is the treatment of choice. The aim of the procedure is to remove the whole cyst without rupture. The operation is performed under general anaesthesia and takes about 30 minutes. You should not have to spend the night in hospital. A cut is made directly over the cyst and it is removed carefully to avoid rupture. The wound is closed with dissolving sutures. Local anaesthetic is injected which will keep the area numb for 6-12 hours after surgery. Waterproof tissue glue is applied as a dressing. It is lilac in colour and takes 2 weeks to fall away.
Your child cannot eat for 6 hours before the procedure. In breast fed babies this time may be reduced by the anaesthetist. Your child can drink water for up to 2 hours before the operation. The Day Surgery Unit will instruct you the day before surgery to confirm fasting times. It is useful to bring your child’s favourite toy along on the day.
The anaesthetist will meet you and your child prior to the procedure. They will discuss the anaesthetic with you and take you through to the operating theatre. Your child will be anaesthetised using a face mask and then you will be taken to a waiting area. Once your child is asleep a drip is inserted often in the hand or arm, but occasionally it may need to be sited in the leg.
On completion of the operation your child will be taken to the recovery area. Children often initially appear distressed and a little confused upon waking up but will quickly settle down once you are with them and if offered a drink or something to eat. Full recovery usually takes about 2-3 hours after which you can go home.
Children’s paracetamol should be given for pain relief for 24 hours. After that use paracetamol only if needed. Some children need additional medication such as ibuprofen or celecoxib. Opiate (morphine-type) medications are not usually required. Paracetamol and ibuprofen can be given at the same time and work well together. Follow the dosages recommended on the packaging or by the anaesthetist. Never give more than has been prescribed.
It is quite normal for the neck on the side of the operation to look swollen and there may be some bruising. This usually resolves in week or so.
In general, your child may eat a normal diet after surgery. Vomiting is common on the day of surgery. It is temporary, and usually due to the anaesthetic and pain-relief medications that are used. If vomiting occurs, start with clear liquids and add solids slowly for the first day.
I will review your child 4-6 weeks after the surgery to ensure healing of the wound. For patients from rural areas this may be deferred to your local General Practitioner or Paediatrician. Please ring soon after the operation to arrange a convenient time.
The vast majority of children who have operations to remove branchial remnants recover well and have no serious complications of surgery. Some of the recognised complications of surgery include:
Swelling or bleeding around the airway
This is an immediate post-operative complication and is rare. It can cause difficulty with breathing and may require a trip back to the operating theatre.
There is a small incidence of recurrence (~3%) particularly if there is a history of infection of the branchial remnant.
Infection & Bleeding
As with any surgical procedure there is a 1-2% risk of bleeding or wound infection after surgery. The wound will appear red, be tender to touch and may discharge pus or blood. If this occurs, a course of antibiotics may be required, and you should contact me or present to your General Practitioner or Local Hospital as soon as possible.
Damage to nerves
Branchial anomalies of the face are usually very close to the nerves that control facial movement. Branchial anomalies in the neck are often close to the motor nerve to the tongue and sensory nerves to the throat and occasionally the nerves that control voice. Nerve damage is rare.
Damage to other structures in the neck
Branchial anomalies may course close to blood vessels, the breathing (trachea) and swallowing (oesophagus) tubes and the thyroid and parotid glands. These structures are usually identified and preserved during the operation and damage is rare.
Please refer to the following resources for more information:
This page is intended to provide you with information and does not contain all known facts about branchial anomalies. Treatment may have uncommon risks not discussed here. Please do not hesitate to ask any questions you may have.