First branchial cleft fistula: a case report
Keywords:Branchial cleft anomalies, Facial nerve, Branchial cleft fistula
First branchial cleft anomalies (BCA) are a rare finding in head and neck with incidence of nearly 1 million per year which are distributed below external auditory canal, above the hyoid bone, anterior to sternocleidomastoid and posterior to submandibular triangle. First branchial cleft cysts are frequently misdiagnosed as they are rare and pose unfamiliar clinical signs and symptoms. Here we are reporting a case of surgical management of 1st branchial cleft fistula in a 5 years old male child from AIIMS, Raipur, Chhattisgarh, India as it’s a rare entity. Child presented with discharge from right upper part of neck. There was a swelling in right upper lateral part of neck with an opening also in floor of right external auditory canal (EAC). Contrast enhanced computed tomography of neck showed a 4.8 cm long obliquely oriented fistulous tract opening at junction of middle and upper one third of sternocleidomastoid with opening in right EAC. Surgical excision of the fistulous tract was done with preservation of facial nerve. Histopathology examination confirmed the presence of fistula. Common clinical presentation of BCAs is pre-auricular swelling (24%), parotid swelling (36%) or cervical region swelling (41%). In our case, it was a fistulous opening that presented as discharging tract in upper neck. Management include early diagnosis, control of infection and complete excision with facial nerve preservation Surgical approach should be based on the clinical examination, imaging and clinical course; and there is a need to safely identify and preserve facial nerve in almost all cases.
Chavan S, Deshmukh R, Karande P, Ingale Y. Branchial cleft cyst: a case report and review of literature. J Oral Maxillofacial Pathol. 2014;18:150.
Bajaj Y, Ifeacho S, Tweedie D, Albert DM, Cochrane LA, Wyatt ME. Branchial anomalies in children. Int J Pediatric Otorhinolaryngol. 2011;758:1020-3.
Shinn JR, Purcell PL, Horn DL, Sie KC, Manning S. First branchial cleft anomalies: otologic manifestations and treatment outcomes. Otolaryngol Head Neck Surg. 2015;152:506-12.
Arvind K, Vijayalakshmi R. A type 1 Branchial cleft cyst masquerading as parotid tumour. Natl J Maxillofac Surg. 2014;5:84-5.
Quintanilla-Dieck L, Virgin F, Wootten C, Goudy S, Penn E. Surgical Approaches to First Branchial Cleft Anomaly Excision: A Case Series. Case Reports Otolaryngol. 2016;3902974.
Waldhausen JH. Branchail Cleft and arch anomalies in children. Semin Pediatr Surg. 2006;15:64-9.
Triglia JM, Nicollas R, Ducroz V, Koltai PJ. Frist branchial cleft anomalies: A study of 39 cases and review of literature. Arch Otolaryngol Head Neck 1998;124:291-5.
Work WP. Newer concepts of first branchial cleft defects. Laryngoscope. 1972;82:1581-93.
Goudakos JK, Blioskas S, Psillas G, Vital V, Markou K. Duplication of the external auditory canal: two cases and a review of the literature. Case Reports in Otolaryngol. 2012:ID924571:4.