International Journal of Pediatric Otorhinolaryngology
CASE REPORTComplete fistula of the second branchial cleft: case report of catheter-aided total excision
Introduction
Developmental anomalies of the branchial apparatus include cysts, sinuses and fistulas, and the second branchial cleft is the structure most often affected [1]. Branchial anomalies may be diagnosed at any age; however, most are detected in the first and second decades of life. According to various studies in the literature, 1–30% of all branchial anomaly cases are bilateral [2]. Fistulas of the second branchial cleft may occur in several members of the same family [3]. The symptoms associated with these tracts include permanent or intermittent mucoid drainage, recurrent inflammatory attacks, cellulitis, and abscess formation. Upper respiratory tract infection and mild trauma are the most common causes of the inflammation. Some patients with anomalies of the second branchial arch may exhibit conductive and/or sensorineural deafness [3]. In cases of branchial fistula with a pinpoint external orifice, the opening is almost always present at birth; however, if there is no drainage, the anomaly may go unnoticed for several years. In patients who have complete or large fistulas, the external opening usually rises with deglutition [3], [4]. One report indicated that anomalies of the second branchial arch are slightly more common in females than in males, and that they tend to occur more often on the right side [5]. The literature contains very few descriptions of primary carcinoma of the branchial cleft [6].
Section snippets
Case
A 13-year-old girl presented with intermittent drainage from the lower right side of her neck, a problem that had existed since birth. Ear, nose and throat (ENT) examination revealed a pinpoint external opening at the anterior border of the lower third of the right sternocleidomastoid muscle. Oral examination revealed nothing abnormal; no orifice was detected in the right tonsillar region. All other findings on ENT assessment were normal, and the patient exhibited no sensorineural hearing loss.
Discussion
Anomalies of the second branchial arch are considerably more common than anomalies of the first, third and fourth arches; however, complete anomalies of the second branchial cleft, as in our case, are very rare [5]. The actual etiology of lateral cervical (branchial) cysts is still uncertain, but four basic theories have been advanced to explain the origin of these lesions: branchial (Ascherson, 1832), precervical sinus (His, 1886), thymopharyngeal duct (Wenglowski, 1912) and lymph node (Lucke,
Conclusion
This report describes a congenital anomaly for which the definitive treatment was surgery. As an addition to a previously described surgical technique for excision, we inserted a catheter into the tract as a guide. The catheter facilitated removal of the tract. In line with the principle of “primum non nocere”, the fistula was excised with minimal damage to surrounding structures, and tonsillectomy was not required. The pathological results in this case appear to support the lymph node theory
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