[Branchial cleft anomalies of the neck : Embryology, clinical presentation, and management].

Branchial cleft anomalies are the second most common congenital neck lesion. They present as cysts, sinuses, or fistulas arising from remnants of the pharyngeal apparatus; second arch anomalies predominate. The embryologic origin determines their anatomical relationships to nerves, vessels, and the pharynx and guides diagnosis and surgical planning. Typical findings are cervical swelling, cutaneous discharge, or recurrent infection. Third and fourth branchial anomalies may cause recurrent neck abscesses or acute suppurative thyroiditis, particularly in children. Ultrasonography is the primary imaging modality. Complete excision during a non-acute inflammatory interval remains the treatment of choice. Endoscopic treatments have become established as the first-line approach for pyriform sinus tract anomalies due to lower morbidity. Branchio-oto-renal syndrome should be considered in patients with ear malformations, hearing impairment, or renal abnormalities.