Fluoroscopic Diagnosis of a Second Branchial Cleft Fistula

Shin, Lewis K.; Gold, Burton M.; Zelman, Warren H.; Katz, Douglas S.

doi:10.2214/ajr.181.1.1810285

Cited by 9 publications

(8 citation statements)

References 3 publications

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“…The fistulas are characteristically lined by stratified squamous epithelium in their external or the lateral part and columnar epithelium along their medial course [1,5]. Pre-operative sinogram and intra-operative filling of sinus tract with methylene blue is helpful in delineating the course of the tract [3,7,8].…”

Section: Discussionmentioning

confidence: 99%

“…Traditionally, a fistulogram is obtained to help in diagnosis and delineation of the tract [2,3,7,8] and the fistula is filled with methylene blue or liquid paraffin intra-operatively to facilitate its dissection [1,7,8]. A metal probe can also delineate the track [9].…”

Section: Discussionmentioning

confidence: 99%

“…While the tract in the branchial sinus merges imperatively in the neighboring soft tissue, it is complete in patients with branchial fistula where the internal opening is usually located in the tonsillar region [1]. Traditionally, a preoperative fistulogram by injecting a water-soluble iodinated contrast medium is obtained to delineate the tract [2,3]. Further, methylene blue injection in the tract has also been used intra-operatively to delineate the tract.…”

Section: Introductionmentioning

confidence: 99%

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Second branchial cleft fistula: Is fistulogram necessary for complete excision

Rattan

Parihar

et al. 2006

International Journal of Pediatric Otorhinolaryngology

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Second branchial cleft fistula: Is fistulogram necessary for complete excision

Rattan

Parihar

et al. 2006

International Journal of Pediatric Otorhinolaryngology

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“…Another case in which a low lying thyroglossal duct cyst with recurrent lateral cervical discharge and no palpable mass which was initially diagnosed as a second branchial arch fistula was reported by Sung-Min Hong et al [7] In both these instances imaging studies helped in reaching the correct diagnosis. Fistulogram is one of the routinely performed and very useful investigations in the diagnosis of branchial fistula, in which the completeness of a fistula is diagnosed by a dye test in which methylene blue is injected through the outer opening and appears in the throat [8]. A negative result can become positive during the time of general anesthesia due to muscle relaxation.…”

Section: Discussionmentioning

confidence: 99%

Infected Branchial Fistula Mimicking As a Branchial Cyst: Two Case Reports

George¹

2017

JOENTR

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Anomalies of the branchial arches are the second most common congenital lesions of the head and neck in children with second arch anomalies the commonest. Eventhough diagnosis of branchial arch anomalies are straightforward, sometimes atypical presentations may cause a dilemma in diagnosis. We are reporting two unusual cases of right infected branchial fistula mimicking as a branchial cyst.diagnosis [1]. Here we are reporting two unusual cases of right infected branchial fistula mimicking as a branchial cyst. Case Report Case 1A six year old female child was brought to the paediatric surgery OPD of PGIMS, Rohtak with a complaint of swelling on right side of neck since birth associated with intermittent mucoid discharge. Swelling gradually increased in size for last one month with purulent discharge from pinhead sized opening over swelling at the junction of middle and lower one third of sternocleidomastoid. Swelling was cystic and non-tender with no overlying skin changes. A clinical diagnosis of infected branchial fistula was made on basis of clinical examination (Figure 1).CECT neck was done which confirmed the diagnosis. The patient was prepared for surgery under general anesthesia. An elliptical incision was given around the opening and flaps were raised. Around 20-30 ml pus was drained. The tract was traced and found passing between internal and external carotid arteries and was opening into tonsillar fossa. Fistula was excised completely and sent for histopathology examination. Post-operative period was uneventful and wound was healthy. Excision of fistulous tract (Figure 2 & 3).Histopathology revealed keratinized squamous epithelium lined tract with mucus secreting glands. Case 25 year old child was brought to the paediatic surgery OPD of IntroductionBranchial arches form the precursors for the development of face, neck and pharynx. Anomalies of the branchial arches are the second most common congenital lesions of the head and neck in children with second arch anomalies the commonest. Eventhough diagnosis of branchial arch anomalies are straightforward, sometimes atypical presentations may cause a dilemma in PGIMS Rohtak with complaints of right sided neck swelling of 4 year duration which also increased in size over two months duration. On examination there was a swelling on the right side of the neck with an opening at its summit. Patient was admitted and was investigated. Imaging studies were done which confirmed the diagnosis of branchial fistula (Figure 4).Excision was done under general anaesthesia. Initially pus was drained and the entire fistula tract was dissected and separated from surrounding tissue after giving an elliptical incision. On dissecting, the tract was found to be densely adhered to the carotid sheath. In this case also postoperative period was uneventful. DiscussionDevelopmental anomalies arising from branchial apparatus include cysts, internal sinuses, external sinuses and complete fistulas. Cyst may exist independently or anywhere along the course of a sinus or fistula. ...

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“…[1] Demonstration of such complete fistulas by fistulogram is considered rare. [2] The branchial fistula arising from each arch can be identified from the position of the internal and external openings. Branchial fistulae are formed due to the abnormal persistence of the embryonic second branchial cleft.…”

Section: Introductionmentioning

confidence: 99%