Unusual presentation of a first branchial arch fistula with maxillofacial infection: a case report.
Unusual presentation of a first branchial arch fistula with maxillofacial infection: a case report.
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第一鳃弓瘘伴颌面感染的异常表现：病例报告。
DOI：
10.1186/s12893-021-01303-2
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发表时间：
2021-07-03
期刊：
影响因子：
1.9
通讯作者：
Zha DJ
中科院分区：
文献类型：
--
作者：
Han Y;Yang RQ;Hong L;Zhong CP;Zha DJ
第一鳃裂异常是一种罕见的先天性缺陷，是由于第一和第二鳃弓的腹侧部分不完全闭合而引起的。FBCA患者临床表现多样复杂，易误诊和治疗不充分。FBCA通常涉及面神经，从而增加了面神经损伤的风险。在这里，我们提出一个不寻常的情况下，FBCA提出了两个耳前小凹与一个异常颌面部囊肿。摘要一个十个月大的女婴，因反复发作的颌面部感染，伴随左脸颊肿胀或脓疡，耳前窝脓性分泌物四个月来到我科求诊。3D计算机断层扫描（CT）瘘管造影和磁共振成像（MRI）显示两处结膜道病变：一处病变起源于外耳道（EAC）前下方的皮肤表面，穿过左侧腮腺深叶，向前延伸至左侧咬肌;另一处病变从左侧腮腺浅叶延伸至耳屏间切迹。经静脉注射抗生素控制颌面部感染后，进行了手术。术中工具，如面神经监测仪，显微镜，和亚甲蓝染料，用于促进面神经的完整解剖和保护。随诊一年以上，患者恢复良好，无面瘫或复发。FBCA合并颌面部囊肿是一种罕见的疾病，容易误诊。医生应注意这种解剖变异的FBCA瘘管位于面神经深处，并向内侧投射到咬肌。
First branchial cleft anomaly (FBCA) is a rare congenital defect that arises due to incomplete closure of the ventral portion of the first and second branchial arches. There are variable complex clinical manifestations for patients with FBCA, which are prone to misdiagnosis and inadequate treatment. FBCAs usually involve the facial nerve with a consequent increased risk of facial nerve damage. Here, we present an unusual case of FBCA presenting with two preauricular pits in association with an abnormal maxillofacial cyst. A 10-month-old girl presented to our department due to recurrent maxillofacial infections accompanied by swelling or abscess of the left cheek and purulent discharge from the preauricular pit for 4 months. A 3D-computed tomography (CT) fistulogram and magnetic resonance imaging (MRI) revealed two conjunctive tract lesions: one tract arose from the skin surface anteroinferior to the external auditory canal (EAC), through the deep lobe of the left parotid, and anteriorly extended to the left masseter; the other extended from the superficial lobe of the left parotid to the intertragic notch. After the maxillofacial infection was controlled by intravenous antibiotic administration, surgery was performed. Intraoperative tools, such as facial nerve monitors, microscopes, and methylene blue dyes, were used to facilitate the complete dissection and protection of the facial nerve. On follow-up over one year, the patient recovered well without facial palsy or recurrence. FBCA with maxillofacial cysts is rare and prone to misdiagnosis. Physicians should pay attention to this anatomic variant of FBCA with the fistula track located deep inside the facial nerve and projected medially to the masseter.
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影响因子：
1.7
作者：
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通讯作者：
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