Complete Second Branchial Cleft Fistulas: A Clinicosurgical Experience.

Autor: Patigaroo SA; Department of ENT, Government Medical College Srinagar, Srinagar, JK India., Hamid WU; Department of ENT, Government Medical College Srinagar, Srinagar, JK India., Ahmed S; Department of ENT, Government Medical College Srinagar, Srinagar, JK India., Dar NH; Department of ENT, Government Medical College Srinagar, Srinagar, JK India., Showkat SA; Department of ENT, Government Medical College Srinagar, Srinagar, JK India., Latoo MA; Department of ENT, Government Medical College Srinagar, Srinagar, JK India.
Jazyk: angličtina
Zdroj: Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India [Indian J Otolaryngol Head Neck Surg] 2023 Sep; Vol. 75 (3), pp. 1517-1524. Date of Electronic Publication: 2023 Mar 06.
DOI: 10.1007/s12070-023-03565-z
Abstrakt: A complete second branchial fistula is very rare and has an internal opening at the tonsillar fossa and an external opening at the lower third of the sternocleidomastoid (SCM). Patients commonly present with persistent or intermittent mucoid or mucopurulent discharge from an external opening. The diagnosis is most often clinical and radiological investigations are rarely needed. Treatment of choice is complete surgical excision. The aim of this article is to aware young ENT surgeons of the various clinical and intraoperative surgical findings that can be encountered while dealing with these cases. This observational study was done for a period of 10 years. A total of 20 cases of fistula were included which intraoperatively had a complete track from tonsillar fossa to neck. Excision of the tract was carried out via combined transcervical and transoral approach under general anaesthesia using two incisions in stepladder pattern. Each patient was seen after one year of surgery to assess for any recurrence. Different findings of patients including age/sex at surgery, initial presentation, family history, laterality of the fistula tract, Intraoperative surgical findings, complications, and recurrences. were noted. Of the 20 patients, 13 (65%) were females and 7 (35%) were Females. Most common complaint was fistulous opening with intermittent discharge(15patients; 75%).Branchial cleft fistulae more commonly affected the right neck (14 patients, 78%) among unilateral cases and 2 patients (10%) had bilateral fistulae. No patient had associated congenital anomaly/syndrome, family history or and visible opening in tonsillar area. Glossopharyngeal nerve was identified in 12 cases and track was seen passing lateral to it except in one case. The internal opening of track was seen over posterior tonsillar pillar in 15 cases (75%) while in 5 patient the track was seen entering tonsillar tissue or bed. Tonsillectomy was done in 5 cases while not done in 15 cases where track was seen entering posterior pillar. All patients were seen at one year follow up. No recurrence was seen at one year of follow up. Complete second branchial cleft fistulae are rare. They are usually right sided and unilateral. The track passes between carotid bifurcation and invariably passes lateral to both glossopharyngeal and hypoglossal nerves. Track usually ends at the posterior tonsillar pillar. Tonsillectomy is not routinely indicated. Recurrences are not typically seen.
Competing Interests: Conflict of interestThere are no financial or non-financial interests that are directly or indirectly related to this work.
(© Association of Otolaryngologists of India 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)
Databáze: MEDLINE
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