Chemocauterization of second branchial cleft fistula using trichloroacetic acid: A preliminary report

Abstract

Objective

Although second branchial cleft fistula (BCF) can be well treated with surgical excision, neck scarring is unavoidable. We previously reported chemocauterization with trichloroacetic acid (TCA) to close various fistulas. Here, we report chemocauterization of a second BCF without a consequent incision scar.

Methods

This procedure was applied in four pediatric patients whose parents were reluctant to undergo surgical excision for a second BCF. Under general anesthesia, a thin metal suction tip or cut down tube was inserted through the skin opening. Normal saline with or without dye was injected to identify the pharyngeal opening around the palatine tonsil, and 75% TCA solution mixed with dye was injected. Leaked TCA at the pharynx was sucked out meticulously to avoid extensive and unexpected injury to the mucosa, and the external opening was sealed with a thin adhesive film.

Results

There were no immediate complications and recurrence of a second BCF in all patients during the median follow-up of 23 months (range, 18–88 months) with minimal neck scarring.

Conclusion

TCA chemocauterization of second BCF could be a simple, less invasive, and feasible treatment option in pediatric patients.

Introduction

Branchial cleft anomalies such as sinuses, fistulas, and cysts arise from an incompletely obliterated branchial cleft during fetal growth [1], [2]. Second branchial cleft anomalies represent the most common type, accounting for 80–95%, and a connection between the skin and pharynx is defined as fistula [2], [3]. Because it opens onto the skin, a second branchial cleft fistula (BCF) is usually noted at an earlier age than a cyst [4]. In general, BCF can be diagnosed by clinical examinations, although ultrasonography, computed tomography (CT), and magnetic resonance imaging have been used to help make a differential diagnosis or obtain detailed anatomical information [4], [5].

Total excision of the fistula tract with or without tonsillectomy is considered the standard treatment for BCF [6]. However, incomplete excision of a BCF can lead to reoperation, and a neck scar is inevitable. For these reasons some patients and parents of pediatrics are reluctant to undergo excision. Trichloroacetic acid (TCA), a chemical agent with the potential to inflict harm on the body such as a chemical burn or ulcer, is used clinically in skin peels and the treatment of warts because of its corrosive properties [7]. To date, we have reported treatments of various fistulas of the head and neck without an open approach using TCA, all of which have achieved satisfactory results [7], [8], [9], [10].

Here, we report four patients with a second BCF who were successfully treated using TCA chemocauterization technique that leaves minimal scarring on the neck.