Classification of first branchial cleft anomalies: is it clinically relevant?

Abstract

Background: There are three classification systems for first branchial cleft anomalies currently in use. The Arnot, Work and Olsen classifications describe these lesions on the basis of morphology, tissue of origin and clinical appearance. However, the clinical relevance of these classifications is debated, as they may not be readily applicable in all cases and may provide no additional information on how the lesion should be managed.

Objective: We seek to investigate this issue by applying these classification systems to cases from our centre and evaluating the information gained.

Patients and methods: A retrospective case note review of all first branchial cleft anomalies excised at our institution between 2004 and 2014 was carried out, recording patient demographics, information on the anomalies and how they were investigated and managed.

Results: This search identified eight unilateral cases and one bilateral case of first branchial cleft anomalies. These were a heterogenous group of lesions, which were variably investigated and managed. Categorization of these cases into Arnot, Work and Olsen subtypes did not correlate with the lesion’s relation with the facial nerve or the outcome of excision.

Conclusion: The current classification systems used for first branchial cleft anomalies have little clinical relevance apart from providing extensive descriptions to aid in diagnosis. We advise instead that clinicians use imaging techniques to gain as much information as possible about these lesions before excision and be aware of the risk to the facial nerve at the time of excision. A description of the lesion’s relation with the facial nerve at the time of excision may provide more information on the likely outcomes compared with the classifications currently in use.

Keywords: branchial cleft, congenital anomaly, facial nerve injury, first branchial cleft anomaly