Complete Fistula of the second Branchial cleft: Report of a case with discussion on investigation and treatment aspects.

摘要

Objective: This is the report of a case of complete second branchial cleft fistula. The main objective of this report is to highlight the use of fistulogram for the diagnosis and to suggest the use of rigid guide wire like the tonsil snare wire for the excision.Case report: A 12-year-old girl who presented with an intermittent mucoid discharge from the external opening in the neck on the right side was diagnosed to have a second branchial cleft fistula. A preoperative fistulogram revealed the tract up to the tonsillar fossa. Complete excision of the tract was done by a two step neck incision using tonsillar snare wire as the guide.Conclusion: Though second branchial fistulae are common, complete fistulae are rare and this merits the publication of this report. The report also stresses on the need to perform a preoperative fistulogram and the advantage of using the tonsil snare wire for excision. Introduction Congenital cervical cysts, sinuses, and fistulae must be considered in the diagnosis of head and neck masses in children and adults. Anomalies of the second branchial cleft account for 90% of the developmental abnormalities of the branchial apparatus. Majority of these have an external opening in the neck along the anterior border of sternomastoid at the junction of upper 2/3rd with lower 1/3rd. The internal opening may not always extend up to the posterior pillar of the tonsil as described in the literature. This is the report of a case of complete second branchial cleft fistula which was excised using tonsillar snare wire as the guide. Case Report A 12-year-old Indian female patient presented to the ENT outpatient with the history of a small opening in the lower part of the neck on the right side since birth and intermittent, yellowish white discharge from the opening. On examination, a small opening was seen on the right side of the neck along the anterior border of the sternomastoid at the junction of lower 1/3rd with upper 2/3rd with scanty mucous discharge on pressure. [Fig No. 1]