New facial surgery procedure aims to ease pain, eliminate scarring

Operating around the head and neck is a delicate job. When doctors are dealing with kids, it becomes even trickier.

But a new procedure aims to ease the pain and eliminate scars, all in an effort to allow the smallest patients to grow up without the reminders of surgery.

Twins Colton and Isabella may seem like double trouble, but mom Sarah is just happy to have them around.

When they were born twelve weeks early, the twins went straight to the neonatal intensive care unit.

But the worries didn't end at the hospital. Months later, she noticed two little red marks on Colton's neck.

Colton had "pits," or cysts that had formed in the womb. If left alone, the cysts can cause chronic infection. Colton's had to be removed.

Doctor Mitchell Austin used a new minimally-invasive procedure to take care of the problem. A fiber-optic tool typically used in sinus surgeries enters a small incision in the neck. The surgeon removes the pits with less risk of touching muscles, large arteries, and major nerves in the face.

"Larger surgeries and larger incisions also endanger more nerves that are very, very close to the face. We're going underneath, behind, and below all those areas," explains Dr. Austin.

Traditional surgery through the neck takes two incisions and recovery takes four to seven days. The newer procedure uses one smaller incision and kids can be back to normal in three days.

It also leaves little to no scarring. Colton bounced back quickly.

"When we went into it knowing what could be, and when he woke up it was as if nothing had happened to him, we were very, very relieved," says Colton's mom Sarah Suggs.

Now it's full speed ahead for the twins. Double the work, but double the love.

The minimally-invasive procedure was first developed to remove thyroids in adults. Now it can be used to take tissue samples from lymph nodes and even remove large masses in the neck.


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A branchial cleft cyst is a lump that develops in the neck or just below the collarbone. These abnormalities form during the development of the embryo and are most often found in children between the ages of 2 and 10. They may also form from fluid drained from a sinus.

Branchial cleft cysts are often first detected after an upper respiratory tract infection, which leaves them enlarged. The cysts may have an external opening from which liquid drains. These cysts are often confused with another type of abnormality called preauricular sinus, or preauricular cyst.

About 0.1 to 0.9 percent of people in the United States have this condition (Source: International Journal of Pediatric Otorhinolaryngology). Like branchial cleft cysts, preauricular cysts develop during embryonic development -- specifically, during the sixth week. Unlike branchial cleft cysts, preauricular cysts don't normally involve branches of the facial nerve.


Branchial cleft and preauricular cysts often become infected. When they do, they require antiobiotic treatment. When the problem becomes persistent or the cysts chronically drain, surgery is recommended.

Some research shows the cysts can increase the risk of cancer at their sites later in life. A study published in 2006 describes a 53-year-old man who developed cancer at the site of a branchial cleft cyst. The cancer received its own name -- branchial cleft carcinoma.

An older study set out to properly distinguish this kind of cancer from cancer of the lymph nodes and did so through radiologic evidence. Still, cancer arising from branchial cleft cysts is rare, and doctors mainly recommend removal of the cysts to prevent infection.


In addition to a physical exam and medical history, several procedures may be performed to determine the size and type of cyst a child has. CT scans help pinpoint the exact location and size of the cyst. A biopsy may rule out the possibility of cancer, and fine needle aspiration of the fluid in the cyst may provide further information.


Complete removal of preauricular and branchial cleft cysts normally have good outcomes. The procedure is usually done as an outpatient surgery under general anesthesia, but an overnight stay may be needed if the operation is done deep in the neck.

Surgical treatment for both preauricular sinus and branchial cleft cysts can put the facial nerve at risk of damage. A new minimally invasive approach to the removal of these types of cysts reduces the risk of hitting that nerve, which controls the face and the tongue. The procedure also reduces the likelihood of scarring, which can not only be unsightly but also painful.

Keloids, or excess growth of scar tissue, can form from surgical scars. "The closer you get to the face, the higher incidence of keloid formation ... and keloid formation around the face is hard to treat and may need multiple therapies such as injections and re-surgery," Mitchell Austin, a pediatric otolaryngologist at Nemours Children's Clinic in Orlando, Fla., told Ivanhoe.


Mitchell Austin, MD
Nemours Children's Clinic
Orlando, FL
Public Relations: (407) 650-7462

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