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Case Report | Vol. 6, Issue 3 | Journal of Surgery Research and Practice | Open Access

Bilateral Cervical Chondrocutaneous Branchial Remnant: A Rare Case Report

 

Saket Davera1*, Karunesh Chand2, Kamal Kishore2, Gurjot Singh3, Badal Parikh4, Badal Parikh5

1Department of Surgery, Command Hospital Airforce, Bangalore, India
2Department of Paediatric Surgery Army Hospital (R and R), New Delhi, India
3Department of Surgery, Army Hospital (R and R), New Delhi, India
4Department of Anaesthesia Army Hospital (R and R), New Delhi, India
5Department of Pathology Army Hospital (R and R), New Delhi, India

*Correspondence author: Saket Davera, MCH Paediatric Surgery, Department of Surgery, Command Hospital Airforce, Bangalore, India; Email: [email protected]

Citation: Davera S, et al. Bilateral Cervical Chondrocutaneous Branchial Remnant: A Rare Case Report. J Surg Res Prac. 2025;6(3):1-3.

Copyright© 2025 by Davera S, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Received
08 October, 2025		Accepted
09 November, 2025		Published
17 November, 2025

Abstract

Cervical Chondrocutaneous Branchial Remnants (CCBRs) are rare congenital choristomas characterized by cartilaginous tissue within the cervical skin. We report a case of a 4-year-old girl presenting with bilateral soft tissue swellings in the lower neck, present since birth. Clinical examination and imaging suggested a congenital branchial remnant. Complete surgical excision was performed and histopathology confirmed hyaline cartilage surrounded by normal adnexal structures. Postoperative recovery was uneventful and no recurrence was noted. Bilateral CCBRs are exceedingly uncommon. Awareness of this entity is essential to differentiate it from other congenital neck masses and to evaluate for associated systemic anomalies.

Keywords: Chondro-cutneous Branchial Remnants (CCBR); Cartilaginous Tissue; Congenital Neck Masses

Introduction

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) are rare but potentially life- Cervical chondrocutaneous branchial remnants are lesions comprising a cartilage core surrounded by skin with adnexal structures and subcutaneous fat. Diagnosis can be supported by imaging and histopathology. Management includes complete surgical anomaly which presented to a tertiary care health facility.

Case Report

A 4-year-old girl, with an unremarkable antenatal and postnatal history and normal developmental milestones, presented with bilateral soft tissue swellings in the lower third of the neck, present since birth. The swellings gradually enlarged proportionate to the child’s growth. There was no history of discharge, recurrent infections of the ear/oral cavity or a relevant family history.

Local examination revealed a non-tender tubular swelling measuring 3 × 1 cm on the left side and a smaller papular lesion on the right, located superior and lateral to the sternocleidomastoid insertion (Fig. 1). Both lesions had heterogeneous consistency with soft and firm components. The overlying skin was intact with no sinuses or discharge. No other cervical abnormalities or systemic congenital anomalies were detected.

Management

A provisional diagnosis of congenital branchial remnant was considered. The patient underwent excision of both lesions. Intraoperatively, the lesions were tubular structures with blind-ending tracts confined to the subcutaneous plane. No deeper extensions were noted. per-operatively on table sectioning revealed cartilaginous tissue surrounded by adipose elements. Postoperative recovery was uneventful, patient is presently under routine OPD follow-up and is undergoing screening for associated congenital anomalies.

Histopathology

Microscopy demonstrated rod-shaped hyaline cartilage surrounded by normal adnexal structures, without features of atypia or mitosis (Fig. 2).

Figure 1: Clinical image of the child.

Figure 2: Photomicrograph of histopathological findings of excised bilateral neck masses. A: Photomicrograph shows a polypoidal lesion line by skin, dermis shows rod shaped mature elastic cartilage with adnexal  structures  and mature adipose tissue (H and E, 4X); B: High power view of elastic cartilage did not show any atypia or increase in mitosis (H and E stain,20X).

Discussion

Cervical Chondrocutaneous Branchial Remnants (CCBRs) are uncommon benign congenital anomalies classified as choristomas, representing heterotopic cartilage within cervical skin [1-6]. They share similarities with preauricular tags but are rarely found in the lateral neck region. Various terms, including “accessory tragus” “cervical auricle” and “wattle” have been used in literature to describe these lesions. The entity was first documented in 1858 and the largest case series of 17 patients was later reported by Atlan, et al., highlighting a male preponderance [3,7]. The frequency of associated anomalies varies widely across case reports, with cardiac and renal malformations being the most frequently described and ranges between 0-76%. Bilateral CCBRs, such as in our case, are exceedingly rare, with only about ten cases documented till date. The precise embryological origin of cervical chondrocutaneous branchial remnants remains a subject of debate. The most widely accepted hypothesis postulates that these lesions represent vestigial derivatives of the branchial arches most commonly the second or lower arches-arising due to incomplete obliteration of the branchial apparatus. Diagnosis is predominantly clinical; however, imaging modalities may be employed to exclude deeper extensions or associated anomalies, particularly involving the cardiovascular and genitourinary systems. Tamir, et al., advocate surgical excision prior to school age, minimizing operative risks and mitigating potential psychosocial distress [8]. Complete excision is curative, with no documented instances of recurrence or malignant transformation. Histopathological evaluation typically reveals hyaline cartilage, although occasional cases may demonstrate elastic cartilage.

Conclusion

Bilateral cervical chondrocutaneous branchial remnants are a rare presentation of branchial anomalies. They typically present as asymptomatic soft tissue outgrowths without sinus formation. Clinical diagnosis is usually sufficient, though evaluation for associated congenital conditions is recommended. Complete surgical excision is curative and histopathology confirms the diagnosis by demonstrating cartilaginous remnants within dermal tissue.

Conflict of Interest

The authors declare no conflict of interest.

References

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Saket Davera1*, Karunesh Chand2, Kamal Kishore2, Gurjot Singh3, Badal Parikh4, Badal Parikh5

1Department of Surgery, Command Hospital Airforce, Bangalore, India
2Department of Paediatric Surgery Army Hospital (R and R), New Delhi, India
3Department of Surgery, Army Hospital (R and R), New Delhi, India
4Department of Anaesthesia Army Hospital (R and R), New Delhi, India
5Department of Pathology Army Hospital (R and R), New Delhi, India

*Correspondence author: Saket Davera, MCH Paediatric Surgery, Department of Surgery, Command Hospital Airforce, Bangalore, India;
Email: [email protected]

Saket Davera1*, Karunesh Chand2, Kamal Kishore2, Gurjot Singh3, Badal Parikh4, Badal Parikh5

1Department of Surgery, Command Hospital Airforce, Bangalore, India
2Department of Paediatric Surgery Army Hospital (R and R), New Delhi, India
3Department of Surgery, Army Hospital (R and R), New Delhi, India
4Department of Anaesthesia Army Hospital (R and R), New Delhi, India
5Department of Pathology Army Hospital (R and R), New Delhi, India

*Correspondence author: Saket Davera, MCH Paediatric Surgery, Department of Surgery, Command Hospital Airforce, Bangalore, India;
Email: [email protected]

Copyright© 2025 by Davera S, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation: Davera S, et al. Bilateral Cervical Chondrocutaneous Branchial Remnant: A Rare Case Report. J Surg Res Prac. 2025;6(3):1-3.

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