Unusual case of congenital fistula between external auditory canal and nasopharynx
Keywords:Branchial region abnormalities, Congenital fistula, MR fistulogram, External auditory canal, Nasopharynx
Defects in the development in the neck area of the embryo result in branchial cleft anomalies. Various first branchial cleft anomalies are described in literature including preauricular sinuses, cysts and collaural fistula. In our case study, we document a very unusual case of fistula between floor of external auditory canal and nasopharynx. Such patient requires thorough evaluation and step-wise approach to treat. After clinical examination and radiological evaluation, surgically the fistula was excised in toto via external approach using Modified Blair’s incision. In our case, fistulous tract was running from external auditory canal to nasopharynx, running superior and medial to the trunk of facial nerve. No such case is found to be reported in literature after extensive search. Hence, it would be strongly advocated to keep this presentation in the differential diagnosis during evaluation. Also, it is worth mentioning and recommending that a careful radiological examination is a must before approaching for surgery.
Adams A, Mankad K, Offiah C, Childs L. Branchial cleft anomalies: a pictorial review of embryological development and spectrum of imaging findings. Insights Imaging. 2016;7(1):69-76.
Schoenwolf G, Bleyl S, Brauer P, Francis WP. Larsen’s Human Embryology, 4th ed. New York, Churchill Livingston; 2009.
Koeller KK, Alamo L, Adair CF, Smirniotopoulos JG. Congenital cystic masses of the neck: radiologic-pathologic correlation. Radiographics. 1999;19(1):121-46.
Harnsberger HR, Mancuso AA, Muraki AS, Byrd SE, Dillon WP, et al. Branchial cleft anomalies and their mimics: computed tomographic evaluation. Radiology. 1984;152(3):739-48.
Kerr A, Adams D, Cinnamond M. Paediatric Otolaryngology. 6th ed. Butterworth-Heinemann; 1997.
Watkinson J, Clarke R. Scott-Brown's Otorhinolaryngology And Head And Neck Surgery. 8th ed. Milton: Chapman and Hall; 2018: 466-467.