Complete Second Branchial Fistula: A Study of Four Cases

Abstract

Objective: Complete branchial cleft fistulae are rare anomalies of branchial cleft apparatus. Incomplete fistulae are more common to occur which may not be symptomatic at all and neglected as it do not give rise to recurrent infection. W hile complete brancial fistula gives persistent symptom of discharge from the fistula. This is a report of four cases of complete branchial fistulae which were diagnosed and treated surgically in a span of 2 years in the Department of ENT, Head and Neck Surgery, Rural Medical College and Pravara Rural Hospital, Loni. The main objective of this report is the use of fistulogram for the diagnosis and complete excision of fistula including the both inner and outer ends of fistulae.Case report: Four cases were reported in the age group between 11 and 22 years who presented with an intermittent mucoid discharge from an external opening in the neck since birth with right to left ratio being 4:1 and male:female ratio being 1:1 and were diagnosed to have a second branchial cleft fistula. A preoperative fistulogram revealed the tracts up to the tonsillar fossa with connection over the skin surface in the neck. Complete excision of the tracts were done by a two-step or step ladder neck incision.Conclusion: Though second branchial fistulae are common, complete fistulae are rare with its complete excision. The report also stresses on the importance of a preoperative fistulogram for the preoperative diagnosis and correct complete surgical treatment.

Complete Second Arch Branchial Fistula

“…The branchial fistula arises from breakdown of the endoderm, mostly in the second pouch. A complete second branchial fistula has an internal opening at the tonsillar fossa and an external opening at the skin in the line of the anterior border of the sternocleidomastoideus muscle (1)(2)(3). This copy is for personal use only.…”