Branchial Cleft Cysts, Sinuses, and Fistulas

A combined approach excision of branchial fistula

“…The second branchial cleft fistula and sinus is encountered along the anterior border of the sternocleidomastoid muscle in its lower third and may be bilateral (Telander and Deane, 1977). Its course is deep to the platysma muscle between the second and third pharyngeal arch structures by ascending along the carotid sheath and passing medially between the internal and external carotid arteries above the glossopharyngeal nerve and below the stylohyoid ligament (Chandler and Mitchell, 1981). The fistula may open into the pharynx usually in the region of the intertonsillar cleft of the palatine tonsils.…”

Surgical management of a case of third branchial pouch fistula

“…The fistulous tract may course along one of three routes -through the left thyroid lobe and lateral to, or medial to, the left thyroid lobe (Miyachi et al, 1981). It passes posterior to the glossopharyngeal nerve and internal carotid artery, crossing over the hypoglossal and superior laryngeal nerves and then pierces the thyrohyoid membrane to enter the pyriform fossa (Chandler and Mitchell, 1981) (see Figure 3). This is unlike the more common second pouch fistula with a tract passing between the two carotid arteries and an internal opening in the posterior tonsillar pillar (Ellis, 1987).…”

“…The sinuses and fistulae are lined by squamous or respiratory epithelium. Respiratory epithelium may undergo metaplasia to squamous epithelium due to recurrent infection (Chandler and Mitchell, 1981).…”

“…Third and fourth arch fistulae were largely grouped under "branchial cleft/pouch anomalies' in general, along with the more common first and second arch fistulae. Chandler and Mitchell (1981) described the embryological aspects of the third and fourth arch fistulae lucidly. Since then, Miyachi etal.…”

Case report of a p16INK4A-positive branchial cleft cyst

“…Considerable controversy remains regarding the aetiology of the lateral cleft cyst, sinus or fistula since it was first described in 1785; 1 however, it is widely believed to be branchiogenic in origin 2 . Some authors have rejected the branchiogenic theory in favour of the growing evidence for a cystic lymph node origin 1 , 3 , 4 . Lateral cervical cysts are reported to be aetiologically distinct from sinuses and fistulae, and many mechanisms are proposed to be involved in their pathogenesis 1 , 2 , 5 .…”