Second Branchial Cleft Fistula with Complete Excision

Musa, Zalilah; Mohamad, Irfan; Khairani Nik Mohamad, Nik
February 2013
International Medical Journal;Feb2013, Vol. 20 Issue 1, p44
Academic Journal
Introduction: Branchial cleft anomalies arising from incomplete resolution of pharyngeal cleft may present with sinuses, cysts, or recurrent abscess in the neck. Second cleft lesions are most common anomalies encountered and second cleft sinus is the most common presentation. Branchial cleft fistula is the rarest form of presentation. Objective: To present a rare case of branchial cleft fistula treated with complete excision. Clinical features: A 31 year old Malay man presented with history of recurrent discharge coming out from an external opening at the lower third of anterior part of right sternocleidomastoid muscle. Clinical examination revealed a small external opening at anterior border of lower â…“ of right sternocleidomastoid (SCM) muscle. Oral examination revealed no abnormality and no opening detected in the oropharynx including a detailed search in the right tonsillar region Contrast fisulography showed a fistulous tract extending from the opening in the neck at the junction of upper â…” with lower â…“ of anterior SCM to right tonsillar region. Complete surgical excision of fistulous tract using stepladder approach was performed under general anesthesia. Pathological examination showed a tract lined by stratified squamous epithelium and respiratory epithelium which confirmed the diagnosis of complete fistula of second branchial arch. During follow up until after 6 months post operatively, he was free from complications including any sign of infection or recurrence. Conclusion: Congenital anomaly of second branchial cleft may present as sinus, cyst or fistula. Being the rarest presentation, fistulas usually have the external cutaneous opening at the junction of lower 1/3 and upper 2/3 of anterior border of right SCM muscle while the internal opening usually located at right tonsillar fossa as seen in our case. Complete surgical excision is important to avoid recurrence. It can be done in various methods and stepladder approach is one of them.


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