Abstract / Summary
BackgroundSecond branchial cleft anomalies (SBCAs) are the most prevalent anomalies of the branchial apparatus.Their presentation in adults poses a diagnostic challenge due to their resemblance to other cystic neck pathologies and is infrequently reported. Materials and methodsThis retrospective case series reviewed 52 adult patients who underwent surgical treatment for SBCA at a tertiary center over a 15-year period (January 2009 to December 2023). ResultsBranchial cysts were the most common presentation, accounting for 35 patients (67.3%), typically presenting as right-sided upper neck swelling, and were more common in women (30 patients, 57.7%).Preoperative imaging was performed in 44 patients (84.6%), with CT and MRI demonstrating diagnostic accuracies of 86.7% and 84%, respectively.Preoperative and postoperative diagnoses were concordant in 41 patients (80.4%); most discordance arose from lesions suspected to be tuberculous lymphadenitis or malignant neck nodes.Surgical excision was performed in 51 patients (98.1%), with postoperative complications occurring in six patients (11.5%), predominantly nerve palsies.Follow-up data were available for 28 patients (53.8%).Recurrence occurred in two patients (7.1%), both of whom had undergone prior procedures before definitive surgery and had Bailey type III lesions. ConclusionsSuccessful management requires a high index of clinical suspicion supported by comprehensive imaging for accurate diagnosis in adults.Complete surgical excision by an experienced surgeon achieves a low recurrence rate, although prior interventions and nerve-related morbidity remain relevant risks requiring careful counseling.