Diagnosis and Management of Cervical Vestigial Pathologies in Children: A Retrospective Study of 25 Cases in the Drâa-Tafilalet Region of Morocco.

Background Cervical vestigial pathologies are common congenital anomalies in children, arising from embryological remnants of the branchial apparatus and the thyroglossal duct. They constitute an important etiology of cervical masses in pediatric otolaryngology practice. Objective This study aimed to characterize the epidemiological, clinical, and therapeutic specificities of cervical vestigial pathologies in children in the Drâa-Tafilalet region of Morocco and to compare our findings with data from the literature. Methods We conducted a retrospective descriptive study over a one-year period (January-December 2025) in the Department of Otolaryngology-Head and Neck Surgery at Al Amir Sultan Hospital, Errachidia, Morocco. A total of 25 pediatric patients diagnosed with cervical vestigial pathologies were included. Epidemiological, clinical, radiological, therapeutic, and histopathological data were collected and analyzed. Results The mean age at diagnosis was 6.8 years (range: 2-16 years), with a slight male predominance (13 males, 12 females; sex ratio: 1.08). Cervical swelling was the most frequent presenting symptom. Thirteen patients presented with a cervical mass (10 midline, three lateral). The initial presentation was infectious in six cases, fistulization in five cases, and compressive symptoms in one case. Thyroglossal duct cysts were the most common lesions (12 cases, 48%), followed by second branchial cleft cysts (five cases, 20%), thyroglossal duct fistulas (three cases, 12%), dermoid cysts (three cases, 12%), and cystic lymphangiomas (two cases, 8%). Ultrasound was performed in all patients; computed tomography (CT) was required in two cases. All patients underwent surgical excision. The Sistrunk procedure was used for thyroglossal duct lesions; complete excision of the fistulous tract was performed for branchial anomalies. Histopathological examination confirmed the diagnosis in all cases. No postoperative complications were recorded. Recurrence occurred in one patient (4%) and was successfully managed by revision surgery. Conclusion Cervical vestigial pathologies in children are predominantly benign but require accurate diagnosis and complete surgical excision to prevent recurrence. The Sistrunk procedure and complete fistulous tract excision remain the gold standard treatments in this setting.