First branchial cleft cyst excision with electrophysiological facial nervelocalization

Objective: To assess the safety and efficacy of surgical excision of select ed first branchial cleft cysts using electrophysiological rather than anato mical location of the facial nerve. Design: Retrospective review of consecutive surgical procedures by a single surgeon, using a consistent technique during a 9-year period. Setting: Tertiary pediatric medical center. Patients: Eleven children with first branchial cleft cysts. Interventions: Selected first branchial cleft cysts were removed using a sm aller surgical approach than that generally advocated. The facial nerve was localized using electrophysiological means rather than superficial parotid ectomy and identification of the nerve trunk and branches. Main Outcome Measures: Successful removal of the lesion, avoidance of facia l nerve injury, incidence of Fry syndrome, and cosmesis. Results: Eleven patients underwent surgical excision of first branchial cle ft cysts during a 9-year period. Ten lesions were removed without the need for anatomical localization of the facial nerve trunk. There was no facial weakness, recurrence of the lesions, or Fry syndrome during a follow-up of 6 months to 7 years. Cosmesis was superior. Conclusion: Electrophysiological location of the facial nerve may, in the a ppropriate setting, replace anatomical localization for first branchial cle ft cysts that are (1) superior to the stylomastoid foramen and (2) not prev iously infected or surgically violated.