First branchial cleft cyst excision with electrophysiological facial nerve localization.

OBJECTIVE To assess the safety and efficacy of surgical excision of selected first branchial cleft cysts using electrophysiological rather than anatomical 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 smaller surgical approach than that generally advocated. The facial nerve was localized using electrophysiological means rather than superficial parotidectomy and identification of the nerve trunk and branches. MAIN OUTCOME MEASURES Successful removal of the lesion, avoidance of facial nerve injury, incidence of Fry syndrome, and cosmesis. RESULTS Eleven patients underwent surgical excision of first branchial cleft 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 appropriate setting, replace anatomical localization for first branchial cleft cysts that are (1) superior to the stylomastoid foramen and (2) not previously infected or surgically violated.