The Anomaly

When Cody was born, the doctors were worried at first. Doctors worrying over things that don’t need to be worried over is nothing new, of course. But in this case, they were worried because of a small birth defect they noticed. He had some trouble breathing when he first came out, and they thought that he may have had a defect in his trachea because of the defect that they could see on the side of his neck. Of course, everything turned out to be fine, and there is nothing wrong with his trachea. He was simply born with a little, benign growth on his neck and another smaller one next to his ear.

Cory and I have never been too concerned over his “skin tag” as we used to call it. We didn’t think it was a problem (and we were right), so it took us 10 months or so to get around to taking him to an ENT (ear, nose, and throat) specialist to get it officially checked out, as recommended by Cody’s pediatrician. When we finally did take him, the doctor almost immediately told us what it was—a second branchial cleft anomaly. He recommended surgery to remove it, preferably (for him, the surgeon) soon.

When we got home, of course, I researched as much as I could about his “anomaly.” It didn’t take long for me and Cory to decide that no, we would not be putting our infant through surgery to remove it. As it turns out, these things are benign and the only reason for removing them is because of the possibility of infection. Well, if and when it becomes infected, that is when we will consider the necessity of surgery. The idea of Cody having surgery made me so anxious, it was a huge relief when we decided against it, at least for the time being.

But I was still confused about one thing. In my research on second branchial cleft anomalies, I found over and over again that they come in three forms: cysts, sinuses, or fistulas. Basically, when the baby is developing in the womb there are branchial clefts that develop into different parts of the inner face and neck. This particular defect occurs when the second branchial cleft doesn’t develop quite right. It can appear as a cyst, which is a fluid-filled lump under the skin, or as a sinus, which is a sort of groove in the tissue of the neck, or as a fistula, which as far as I understand it is a tube-like passageway (fistulas are extremely rare, apparently). The problem for me was that Cody’s “anomaly” was not any of these things. It’s like a large skin tag, not filled with fluid, and it has cartilage at the base. He also has a smaller skin tag right in front of his ear on the same side. None of the material I read on second branchial cleft anomalies included what looks like a skin tag or a growth as a possible form.

I put the issue aside for a long time, but today I was curious so I did some more research. It took me a very long time to find it, but I finally found out that Cody’s birth defect isn’t exactly a second branchial cleft anomaly, or at least not a typical one, but it’s actually called a— (get ready, this is a mouthful)— cervical chondrocutaneous branchial remnant with an associated preauricular tag. Let’s break this down, shall we?

“Cervical” means neck, “chondro” means cartilage, “cutaneous” means skin, and “branchial remnant” refers to the whole embryonic development mishap in the branchial cleft that I explained before, resulting in an “anomaly” or unusual formation. Altogether, it’s a perfect description of Cody’s growth. They are also most common in boys, always congenital (present at birth), and often come with another related defect. The skin tag next to Cody’s ear is commonly associated with these branchial remnants, and it’s called “preauricular” meaning “in front of the ear.” For an extremely rare and largely undocumented birth defect, Cody seems to be a textbook example.

Although I’m not sure why these types of anomalies aren’t mentioned in any of the research I found on second branchial cleft anomalies, from what I can tell, it still is one. Which means this information doesn’t change anything, except that it gives me more understanding and peace about it. Having a name for it, and knowing that yes, it is in fact benign, is very comforting for me.

I wanted to write this because I thought it was interesting, and also because there may be parents out there whose children have the same thing that Cody has, and who are frustrated by the confusing information on the internet (and possibly from their own doctors) about what exactly it is. So now you know! Yay, information!

The comforting reality is that these “anomalies” are not a health problem unless they become infected. Cysts, which contain fluid, can often become infected, but this a chondrocutaneous remnant, made up of cartilage and skin, not a cyst. Realistically, the only reason to have them removed is for aesthetic purposes. To put a baby through surgery for such a minor aesthetic purpose seems strange to me, but I’m not here to judge other parents for their choices. For me and Cory, though, we have decided that since there is no health risk, we aren’t going to have surgery for Cody until he is old enough to decide for himself. If, when he’s older, he feels self-conscious about it and wants to have it removed, we will support that. Honestly, it is my hope that we can raise him with enough confidence to not be bothered by it. But again, if having it removed will make him feel better about himself, I can live with that too. For now, I think he’s perfect just the way he is. 🙂