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Li Y, Wang S, Zhang J, Zhang X, Liu Q, Sun N, Liu Z, Ni X. Clinical Analysis of 76 Cases of Second Branchial Cleft Fistula. EAR, NOSE & THROAT JOURNAL 2024:1455613231206287. [PMID: 38577914 DOI: 10.1177/01455613231206287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Objective: To provide the experience of diagnosis and treatment of second branchial cleft fistula in children. Methods: The clinical data of 76 children with second branchial cleft fistulas admitted to Beijing Children's Hospital affiliated with Capital Medical University from January 2016 to December 2020 were retrospectively analyzed. All patients underwent cervical ultrasonography and resection of the second branchial cleft fistula, and their clinical manifestations, surgical methods, complications, recurrence condition, and lesion appearance of the patients were analyzed. Results: Among the 76 cases, the lesions of 43 cases were on the right side, 20 were on the left side, and 13 were bilateral, for a total of 89 lesions. There were 49 type I lesions, 28 type II lesions, 8 type III lesions, and 4 type IV lesions. Type I and type II cases underwent complete excision of the fistula through a small incision in the neck; 2 cases of type III branchial cleft fistulas were treated with trapezoidal incision; 2 cases of type III branchial cleft fistulas underwent single transverse incisions; single small incision-assisted endoscopic resection was adopted in 4 cases of type III and 4 cases of type IV branchial cleft fistulas. During the follow-up period of 6 to 60 months, only 3 cases developed postoperative infection, the others had no postoperative complications, and no cases had recurrence during postoperative follow-up. Conclusion: The incision of the second branchial fistula should be selected according to imaging examination to achieve removal of the fistula while maintaining esthetics.
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Affiliation(s)
- Yanzhen Li
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, P.R. China
| | - Shengcai Wang
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, P.R. China
| | - Jie Zhang
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, P.R. China
| | - Xuexi Zhang
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, P.R. China
| | - Qiaoyin Liu
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, P.R. China
| | - Nian Sun
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, P.R. China
| | - Zhiyong Liu
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, P.R. China
| | - Xin Ni
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, P.R. China
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Patigaroo SA, Hamid WU, Ahmed S, Dar NH, Showkat SA, Latoo MA. Complete Second Branchial Cleft Fistulas: A Clinicosurgical Experience. Indian J Otolaryngol Head Neck Surg 2023; 75:1517-1524. [PMID: 37636759 PMCID: PMC10447783 DOI: 10.1007/s12070-023-03565-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 02/02/2023] [Indexed: 03/08/2023] Open
Abstract
A complete second branchial fistula is very rare and has an internal opening at the tonsillar fossa and an external opening at the lower third of the sternocleidomastoid (SCM). Patients commonly present with persistent or intermittent mucoid or mucopurulent discharge from an external opening. The diagnosis is most often clinical and radiological investigations are rarely needed. Treatment of choice is complete surgical excision. The aim of this article is to aware young ENT surgeons of the various clinical and intraoperative surgical findings that can be encountered while dealing with these cases. This observational study was done for a period of 10 years. A total of 20 cases of fistula were included which intraoperatively had a complete track from tonsillar fossa to neck. Excision of the tract was carried out via combined transcervical and transoral approach under general anaesthesia using two incisions in stepladder pattern. Each patient was seen after one year of surgery to assess for any recurrence. Different findings of patients including age/sex at surgery, initial presentation, family history, laterality of the fistula tract, Intraoperative surgical findings, complications, and recurrences. were noted. Of the 20 patients, 13 (65%) were females and 7 (35%) were Females. Most common complaint was fistulous opening with intermittent discharge(15patients; 75%).Branchial cleft fistulae more commonly affected the right neck (14 patients, 78%) among unilateral cases and 2 patients (10%) had bilateral fistulae. No patient had associated congenital anomaly/syndrome, family history or and visible opening in tonsillar area. Glossopharyngeal nerve was identified in 12 cases and track was seen passing lateral to it except in one case. The internal opening of track was seen over posterior tonsillar pillar in 15 cases (75%) while in 5 patient the track was seen entering tonsillar tissue or bed. Tonsillectomy was done in 5 cases while not done in 15 cases where track was seen entering posterior pillar. All patients were seen at one year follow up. No recurrence was seen at one year of follow up. Complete second branchial cleft fistulae are rare. They are usually right sided and unilateral. The track passes between carotid bifurcation and invariably passes lateral to both glossopharyngeal and hypoglossal nerves. Track usually ends at the posterior tonsillar pillar. Tonsillectomy is not routinely indicated. Recurrences are not typically seen.
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Affiliation(s)
| | - Waqar ul Hamid
- Department of ENT, Government Medical College Srinagar, Srinagar, JK India
| | - Sahil Ahmed
- Department of ENT, Government Medical College Srinagar, Srinagar, JK India
| | - Nisar Hussain Dar
- Department of ENT, Government Medical College Srinagar, Srinagar, JK India
| | - Showkat A. Showkat
- Department of ENT, Government Medical College Srinagar, Srinagar, JK India
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Worden CP, Michaels KC, Magdycz WP. Nonsyndromic bilateral second branchial cleft fistulae: A case report. OTOLARYNGOLOGY CASE REPORTS 2021. [DOI: 10.1016/j.xocr.2021.100308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Meijers S, Meijers R, van der Veen E, van den Aardweg M, Bruijnzeel H. A Systematic Literature Review to Compare Clinical Outcomes of Different Surgical Techniques for Second Branchial Cyst Removal. Ann Otol Rhinol Laryngol 2021; 131:435-444. [PMID: 34137276 PMCID: PMC8899809 DOI: 10.1177/00034894211024049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objective: During the last 2 decades, new treatment methods have been developed for the
surgical removal of second branchial cysts which result in less visible
scars. The aim of this systematic review is to assess which surgical
technique for second branchial arch cyst removal results in the lowest
complication and recurrence rates with the highest scar satisfaction. Methods: Two authors systematically reviewed the literature in the Cochrane, PubMed,
and EMBASE databases (search date: 1975 to December 2nd, 2020) to identify
studies comparing surgical outcomes of second branchial arch cyst removal.
Authors appraised selected studies on directness of evidence and risk of
bias. Results are reported according to Preferred Reporting Items for
Systematic Reviews and Meta-Analyses statement. Results: Out of the 2442 retrieved articles, 4 articles were included in the current
review including a total of 140 operated cysts. Only 2 studies included
pre-operatively infected cysts. Follow up ranged from 3 to 24 months.
Complication rates ranged from 0 to 27.3% (conventional: [0–10.4%];
endoscopic/retro-auricular: [0–27.3%]). None of the patients presented with
postoperative recurrence. Significantly higher scar satisfaction was found
in adult patients who underwent endoscopic or retro-auricular hairline
incision cyst removal. Conclusion: No recurrence of disease occurred during (at least) 3 months of follow up
using either conventional surgery or endoscopic/retro-auricular techniques.
Although more (temporary) complications occur using endoscopic and
retro-auricular techniques, patients report a significantly higher scar
satisfaction 3 to 6 months after surgery in comparison to the conventional
technique. Future studies are needed to support these findings.
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Affiliation(s)
- Sebastiaan Meijers
- Department of Otorhinolaryngology and
Head and Neck Surgery, University Medical Center Utrecht, the Netherlands
| | - Rutger Meijers
- Department of Neurology, Radboud
University Medical Center, Nijmegen, The Netherlands
| | - Erwin van der Veen
- Department of Otorhinolaryngology and
Head and Neck Surgery, University Medical Center Utrecht, the Netherlands
- Central Military Hospital, Utrecht, The
Netherlands
| | - Maaike van den Aardweg
- Department of Otorhinolaryngology and
Head and Neck Surgery, Rivierenland Hospital, Tiel, The Netherlands
| | - Hanneke Bruijnzeel
- Department of Otorhinolaryngology and
Head and Neck Surgery, University Medical Center Utrecht, the Netherlands
- Brain Center Rudolf Magnus, Utrecht,
The Netherlands
- Hanneke Bruijnzeel, MD, PhD, Department of
Otolaryngology and Head and Neck Surgery, Utrecht Medical Center, Heidelberglaan
100, Utrecht 3584 CX, The Netherlands.
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Ragab A, Hussein HA. Endoscopic combined transcervical-transoral second branchial fistulectomy: A novel technique with prospective case series. Int J Pediatr Otorhinolaryngol 2021; 145:110668. [PMID: 33895397 DOI: 10.1016/j.ijporl.2021.110668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/18/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To describe and assess a novel technique of complete endoscopic combined transcervical-transoral fistulectomy (ECCOF) in the management of pediatric complete second branchial cleft (BC) fistula tracts (SBCFTs). METHODS A prospective single-center consecutive case series of SBCFTs was designed. Course and angles of inclination of the tract towards the pharyngeal wall were assessed using CT fistulography. Complete endoscopic fistulectomy was performed using three levels of dissection via ECCOF. Technique, advantages, complications and recurrences were assessed. RESULTS Five children with a mean age of 4.1 ± 0.96 years and seven SBCFTs were included. Four were left-sided fistulae (57.2%), while three were right-sided fistulae (42.8%). The average angle of deep inclination of the fistula tracts between the first and second parts of the fistula tracts (at the carotid bifurcation) was 143.57 ± 10.92°. Complete visualization with safe dissection in all three levels of ECCOF was obtained for all fistulae. No recurrence or complications were observed with an average follow-up of 35.85 ± 22.13 months. CONCLUSION Endoscopic management of SBCFTs appears to be effective and safe. It avoids the prerequisite for wide or double incisions and enables an excellent view of the surrounding structures, which leads to fewer complications and recurrences.
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Affiliation(s)
- Ahmed Ragab
- Department of Otorhinolaryngology, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
| | - Hossam Adel Hussein
- Department of Otorhinolaryngology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
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Second branchial cleft fistula/sinus tract endoscopy: a novel intraoperative technique assisting complete surgical resection. Eur Arch Otorhinolaryngol 2020; 278:833-838. [PMID: 32601920 DOI: 10.1007/s00405-020-06158-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/18/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE Second branchial cleft (BC) sinus/fistula anomalies usually present in children. Their definitive management requires complete tract surgical excision, which necessities accurate extension assessment. Our aim is to propose and describe a novel intraoperative endoscopic technique that can help in evaluating the exact BC anomaly tract extension and overcome disadvantages of currently used methods including imaging and intraoperative methylene blue tract injection. METHODS The innovative intraoperative endoscopic technique involves performing BC sinus/fistula tract intraluminal endoscopy utilizing miniature 1.3 or 1.6 mm all-in-one semi-rigid endoscopes as well as other accessory equipment currently available and used for sialendoscopy for delineation of exact tract extension followed by a complete standard surgical excision tailored to and assisted by the endoscopic procedure. RESULTS This novel endoscopic technique was used successfully in five children (age range 8-16 years) presenting with unilateral or bilateral congenital second BC discharging fistula/sinus tracts in the neck. Intraoperative endoscopic assessment took 10-15 min and confirmed the exact tract extension and nature in all patients without complications. Five fistulas and two sinuses were identified and completely surgically resected. No recurrence has been observed after a median follow-up of 29 (range 13-45) months. CONCLUSION Intraoperative second BC fistula/sinus tract endoscopy could help in accurately assessing anomaly extension, thereby assisting in complete surgical excision. This innovative novel endoscopic technique could avoid disadvantages of currently used methods, especially regarding radiation exposure required for imaging children in whom this anomaly usually presents.
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Thorpe RK, Policeni B, Eigsti R, Zhan X, Hoffman HT. CT Fistulography and Histopathologic Correlates for Surgical Treatment of Branchial Cleft Sinuses. EAR, NOSE & THROAT JOURNAL 2020; 100:976S-978S. [PMID: 32520603 DOI: 10.1177/0145561320933015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ryan K Thorpe
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Bruno Policeni
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Renee Eigsti
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Xin Zhan
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Henry T Hoffman
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Liu H, Cheng A, Ward BB, Wang C, Han Z, Feng Z. Clinical Manifestations, Diagnosis, and Management of First Branchial Cleft Fistula/Sinus: A Case Series and Literature Review. J Oral Maxillofac Surg 2020; 78:749-761. [PMID: 32008991 DOI: 10.1016/j.joms.2019.12.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE First branchial cleft fistula/sinus is a rare congenital developmental deformity that can sometimes be acquired from incision and drainage of a branchial cleft cyst. The aim of the present study was to explore the clinical manifestations, diagnosis, and surgical management of first branchial cleft fistula/sinus in both a large patient series and a review of the pertinent literature. MATERIALS AND METHODS The data from 31 cases diagnosed from February 2004 to April 2019 as first branchial cleft fistula/sinus were retrospectively reviewed. The patient demographic data and outcomes were explored. In addition, we performed a literature review of studies reported from 1923 to 2018 for first branchial cleft fistula/sinus and summarized those results. RESULTS The present study included 31 patients (15 males, 16 females) with a median age of 4 years. All the patients reviewed had presented with a unilateral first branchial cleft fistula/sinus. The parotid region was the most frequent site of presentation (41.9%) in these cases. The fistula/sinus had occurred on the left side in 13 patients (41.9%) and on the right side in 18 patients (58.1%). Of the 31 patients, 24 (77.4%) had acquired the disease from infection of an existing brachial cleft cyst or incomplete previous excision. Of the 31 cases, 28 (90%) had an intimate relationship between the tract and the facial nerve. Despite this close association, no patient developed postoperative facial nerve palsy. Of the 31 operations, 30 (97%) successfully accomplished complete resection with no recurrence postoperatively. Only 1 patient with a history of multiple recurrences experienced a subsequent recurrence, which was successfully treated with a second surgery. CONCLUSIONS First branchial cleft fistula/sinus is a frequently misdiagnosed and, therefore, undertreated entity, which leads to recurrence. It is closely associated with the facial nerve and extra auditory canal. The correct diagnosis and meticulous removal can be effectively achieved with minimal risk to the facial nerve.
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Affiliation(s)
- Huan Liu
- Resident, Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Aoming Cheng
- Resident, Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Brent B Ward
- Department Head, Division of Oral and Maxillofacial Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Chong Wang
- Resident, Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Zhengxue Han
- Department Head, Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Zhien Feng
- Associate Professor, Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China.
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Gong H, Wu C, Zhou L, Tao L. Bilateral second branchial cleft fistulae coexisting with bilateral pre-auricular fistulae: A rare case report. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2020. [DOI: 10.1080/23772484.2019.1709471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Hongli Gong
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Chunping Wu
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Liang Zhou
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Lei Tao
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
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Li L, Liu J, Lv D, Shen T, Deng D, Wang J, Chen F. The utilization of selective neck dissection in the treatment of recurrent branchial cleft anomalies. Medicine (Baltimore) 2019; 98:e16799. [PMID: 31415388 PMCID: PMC6831353 DOI: 10.1097/md.0000000000016799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To investigate the characteristics of recurrent branchial cleft anomalies (BCAs) and to evaluate the surgical technique and outcomes of patients undergoing reoperation.From January 2005 to August 2018, the clinical data of 216 patients with recurrent second, third, and fourth BCAs were retrospectively analyzed. According to the embryological and anatomical features of the cleft palate and recurrence site, selective neck dissection techniques were used for surgical treatment.Among all 216 patients, 203 healed by primary healing. Twelve patients with local infections and 1 patient with a pharyngeal fistula healed after dressing changes. Eleven patients experienced transient hoarseness and recovered after a few months. Three patients developed permanent hoarseness, and 5 patients developed coughing after eating and drinking. Three patients underwent internal jugular vein ligation. Only 4 recurrences occurred during a follow-up period of more than 1 year. The total cure rate was 98.15%.Selective neck dissection is an effective and safe surgical treatment for recurrent second, third, and fourth branchial cleft anomalies.
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Shen LF, Zhou SH, Chen QQ, Yu Q. Second branchial cleft anomalies in children: a literature review. Pediatr Surg Int 2018; 34:1251-1256. [PMID: 30251021 DOI: 10.1007/s00383-018-4348-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2018] [Indexed: 12/13/2022]
Abstract
Branchial cleft anomalies are the second most common head and neck congenital lesions in children. It may sometimes be a part of branchio-oto-renal (BOR) syndrome, so in patients with branchial cleft anomalies associated with a complaint of auricular deformity or a similar history and findings in other family members, we should take an additional examination to find the possibility of BOR syndrome. Complete excision is essential for good prognosis. For the management of branchial cleft anomalies, various methods have been reported. Endoscopically assisted dissection technique and transoral robot-assisted surgery were used in the management of fistula and allowed excellent visualization of the pharyngeal component of the lesion and a minimally invasive approach. It is essential for the surgeon to fully comprehend the congenital lesions to attain the correct preoperative diagnosis and plan for an appropriate surgical approach to prevent the most common complication and recurrence in these lesions. The following sections discuss the anatomy, common presentation, auxiliary examination, differential diagnosis, the current principles of surgical treatment and prognosis for second branchial cleft anomalies in children, and discussed the branchio-oto-renal syndrome.
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Affiliation(s)
- Li-Fang Shen
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China.
| | - Shui-Hong Zhou
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China.
| | - Qiong-Qiong Chen
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
| | - Qi Yu
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
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Kim BH, Kwon SK, Hah J. Chemocauterization of second branchial cleft fistula using trichloroacetic acid: A preliminary report. Auris Nasus Larynx 2018; 45:143-146. [DOI: 10.1016/j.anl.2017.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 03/10/2017] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
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Li W, Zhao L, Xu H, Li X. First branchial cleft anomalies in children: Experience with 30 cases. Exp Ther Med 2017; 14:333-337. [PMID: 28672934 PMCID: PMC5488406 DOI: 10.3892/etm.2017.4511] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 05/15/2017] [Indexed: 12/15/2022] Open
Abstract
First branchial cleft anomalies (FBCA) are rare in the clinical setting, as they account for 1 to 8% of all branchial abnormalities. The purpose of this study is to explore the relationship between the fistula tract and facial nerve and the surgical method of FBCA. This retrospective study included 30 cases of FBCA in children managed from 2009 to 2016. All patients underwent surgery to remove the tract of the FBCA. We reviewed the clinical data of the patients to obtain their demographics and management. Thirty patients (11 male and 19 female) with anomalies of FBCA were diagnosed. The ages ranged from 1 to 13 years (median, 3 years). Twenty cases had a close relationship with the parotid gland. The facial nerve was identified in 20 of the 30 patients. The tract ran deep to the facial nerve in 3 cases, superficial to it in 21 cases, and passed between the branches of the nerve in 6 cases. The facial nerve was not identified in ten patients, as the tract was superficial to it. There were 2 cases of postoperative temporary facial paralysis (2/30, 6.7%). The symptoms gradually improved after one month, 1 case had permanent facial paralysis (1/30, 3.3%), and 1 case had postoperative recurrence. Complete excision of the tract is the only way to manage FBCA, and the course of the tracts vary and have different relationships with the facial nerve. There are 3 types: Superficial, deep to the facial nerve, and between the branches of the nerve. Therefore, surgical approaches differ among the various types, and careful preoperative planning and protecting the facial nerve during resection of the tract are essential.
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Affiliation(s)
- Wanpeng Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, P.R. China
| | - Liming Zhao
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, P.R. China
| | - Hongming Xu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, P.R. China
| | - Xiaoyan Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, P.R. China
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Piccioni M, Bottazzoli M, Nassif N, Stefini S, Nicolai P. Intraoperative use of fibrin glue dyed with methylene blue in surgery for branchial cleft anomalies. Laryngoscope 2016; 126:2147-50. [PMID: 26927898 DOI: 10.1002/lary.25833] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVES/HYPOTHESIS We present a new method of optimizing the results of surgery for branchial cleft anomalies based on the intraoperative injection of fibrin glue combined with methylene blue dye. STUDY DESIGN Retrospective single-center cohort study. METHODS The method was applied in 17 patients suffering from branchial anomalies. Six (35.29%) had a preauricular lesion; three (17.65%) had lesions derived from the first arch/pouch/groove (type I), four (23.53%) had lesions derived from the first (type II), one (5.88%) had lesions derived from the second, one (5.88%) had lesions derived from the third, and two (11.76%) had lesions derived from the fourth. The median and mean age at surgery were 10 and 10.6 years, respectively. All patients were followed by periodic clinical and ultrasonographic examination. RESULTS The combination of fibrin glue with methylene blue facilitated the correct assessment of the extension of the lesions and their intraoperative manipulation. After a mean follow-up of 47.8 months, all patients were free of disease. CONCLUSIONS Intraoperative injection of branchial fistulae and cysts by a mixture of fibrin glue and methylene blue is an effective, easy, and safe tool to track lesions and achieve radical resection. The technique requires a definitive validation on a large cohort with adequate stratification of patients. LEVEL OF EVIDENCE 4 Laryngoscope, 126:2147-2150, 2016.
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Affiliation(s)
- Michela Piccioni
- Department of Pediatric Otolaryngology, Spedali Civili, Brescia, Italy
| | - Marco Bottazzoli
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Nader Nassif
- Department of Pediatric Otolaryngology, Spedali Civili, Brescia, Italy
| | - Stefania Stefini
- Department of Pediatric Otolaryngology, Spedali Civili, Brescia, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
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16
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Kajosaari L, Mäkitie A, Salminen P, Klockars T. Second branchial cleft fistulae: patient characteristics and surgical outcome. Int J Pediatr Otorhinolaryngol 2014; 78:1503-7. [PMID: 25012195 DOI: 10.1016/j.ijporl.2014.06.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 06/10/2014] [Accepted: 06/14/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUNDS Second branchial cleft anomalies predispose to recurrent infections, and surgical resection is recommended as the treatment of choice. There is no clear consensus regarding the timing or surgical technique in the operative treatment of these anomalies. Our aim was to compare the effect of age and operative techniques to patient characteristics and treatment outcome. METHODS A retrospective study of pediatric patients treated for second branchial sinuses or fistulae during 1998-2012 at two departments in our academic tertiary care referral center. Comparison of patient characteristics, preoperative investigations, surgical techniques and postoperative sequelae. RESULTS Our data is based on 68 patients, the largest series in the literature. One-fourth (24%) of patients had any infectious symptoms prior to operative treatment. Patient demographics, preoperative investigations, use of methylene blue, or tonsillectomy had no effect on the surgical outcome. There were no re-operations due to residual disease. Three complications were observed postoperatively. CONCLUSIONS Our patient series of second branchial cleft sinuses/fistulae is the largest so far and enables analyses of patient characteristics and surgical outcomes more reliably than previously. Preoperative symptoms are infrequent and mild. There was no difference in clinical outcome between the observed departments. Performing ipsilateral tonsillectomy gave no outcome benefits. The operation may be delayed to an age of approximately three years when anesthesiological risks are and possible harms are best avoided. Considering postoperative pain and risk of postoperative hemorrhage a routine tonsillectomy should not be included to the operative treatment of second branchial cleft fistulae.
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Affiliation(s)
- Lauri Kajosaari
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, P.O. Box 220, FI-00029 HUCH, Helsinki, Finland.
| | - Antti Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, P.O. Box 220, FI-00029 HUCH, Helsinki, Finland
| | - Päivi Salminen
- Department of Pediatric Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Tuomas Klockars
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, P.O. Box 220, FI-00029 HUCH, Helsinki, Finland
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Cai Q, Pan Y, Xu Y, Liang F, Huang X, Jiang X, Han P. Resection of recurrent branchial cleft deformity using selective neck dissection technique. Int J Pediatr Otorhinolaryngol 2014; 78:1071-3. [PMID: 24809769 DOI: 10.1016/j.ijporl.2014.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 04/03/2014] [Accepted: 04/04/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study explores application of selective neck dissection technique in recurrent second, third, and fourth branchial cleft deformities. METHODS A total of 19 cases of recurrent second, third, and fourth branchial cleft deformities were treated using the selective neck dissection technique, during which the sternocleidomastoid muscle, cervical anterior muscle, and carotid sheath were contoured. The lesion above the prevertebral fascia was then resected en bloc. Finally, the opening of the internal fistula was ligated and sutured using the purse-string approach. RESULTS Patients in this study had no injures to their internal carotid artery, jugular vein, vagus nerve, accessory nerve, hypoglossal nerve, or recurrent laryngeal nerve. There were also no complications such as poor wound healing. The patients were monitored for 7-73 months and showed no recurrences. CONCLUSIONS Using selective neck dissection to treat second, third, and fourth branchial cleft deformities resulted in en bloc lesion resections and reduced the chance of recurrence. Contouring the sternocleidomastoid muscle, strap muscle, and carotid sheath is key to the surgical procedure, as it leads to en bloc lesion resection while retaining the recurrent laryngeal nerve and carotid sheath.
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Affiliation(s)
- Qian Cai
- Department of Otolaryngology-Head and Neck, Affiliated Second Hospital, Sun Yat-sen University, China.
| | - Yong Pan
- Department of Otolaryngology-Head and Neck, Affiliated Second Hospital, Sun Yat-sen University, China
| | - Yaodong Xu
- Department of Otolaryngology-Head and Neck, Affiliated Second Hospital, Sun Yat-sen University, China
| | - Faya Liang
- Department of Otolaryngology-Head and Neck, Affiliated Second Hospital, Sun Yat-sen University, China
| | - Xiaoming Huang
- Department of Otolaryngology-Head and Neck, Affiliated Second Hospital, Sun Yat-sen University, China
| | - Xiaoyu Jiang
- Department of Otolaryngology-Head and Neck, Affiliated Second Hospital, Sun Yat-sen University, China
| | - Ping Han
- Department of Otolaryngology-Head and Neck, Affiliated Second Hospital, Sun Yat-sen University, China
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A true branchial fistula in the context of branchiootic syndrome: challenges of diagnosis and management. J Plast Reconstr Aesthet Surg 2014; 67:1288-90. [PMID: 24933236 DOI: 10.1016/j.bjps.2014.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/22/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND The presence of a branchial fistula with communication both internally and externally: a 'true' branchial fistula is rare, and may arise in the context of autosomal dominant conditions such as branchiootic syndrome and branchiootorenal syndrome. STUDY We discuss the case of a true branchial fistula, which recurred after initial surgical excision, in a patient with branchiootic syndrome. The residual tract was dissected in a second operation through stepladder neck incisions and removed in toto via an intraoral approach. No renal abnormalities were detected on investigation with ultrasound. DISCUSSION Incomplete excision of a branchial sinus is likely to cause recurrence however intraoperative visualisation of the tract can can sometimes prove challenging. An combined intraoral and external approach aids delineation and tract definition when there is a true branchial fistula and can therefore facilitate a complete excision. Suspicion of an hereditary aetiology should be raised in patients with bilateral or preauricular features, or a positive family history, which may then prompt additional renal and genetic investigation.
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Leask R, Pettey KP, Bath GF. Incomplete reduction of branchial clefts in Mutton Merino lambs. J S Afr Vet Assoc 2014; 85:E1-3. [PMID: 25026979 DOI: 10.4102/jsava.v85i1.964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 11/29/2013] [Accepted: 01/06/2014] [Indexed: 11/01/2022] Open
Abstract
Congenital malformations of the branchial arches, clefts and grooves have not been previously reported in sheep. These defects may be due to infectious agents (especially viruses), toxins or genetic abnormalities. Defects were reported in two of a set of quadruplet lambs born prematurely to an eight-tooth Mutton Merino ewe. The lambs weighed between 2.0 kg and 2.5 kg; this is below the normal expected birth weight of 3.5 kg for quadruplet lambs, below which viability is compromised. The firstborn lamb was severely affected by bilateral oroauricular fistulae. The second lamb was unilaterally affected on the right, less severely than the first. The third lamb was normal and the fourth was mummified. The occurrence of another case in this small flock almost a decade earlier indicates that there could be genetic involvement.
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Affiliation(s)
- Rhoda Leask
- Department of Production Animal Studies, University of Pretoria.
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20
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Bilateral second branchial cleft fistula opening to skin with multiple orifices. J Craniofac Surg 2013; 24:1496-8. [PMID: 23851736 DOI: 10.1097/scs.0b013e31828dce45] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Prabhu V, Ingrams D. First branchial arch fistula: diagnostic dilemma and improvised surgical management. Am J Otolaryngol 2011; 32:617-9. [PMID: 21035911 DOI: 10.1016/j.amjoto.2010.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 09/12/2010] [Indexed: 12/17/2022]
Abstract
First branchial cleft anomalies are uncommon, and only sporadic case reports are published in the literature. They account for 1% to 8% of all the branchial abnormalities. The often variable presentation and tract siting of first arch fistulae have led to misdiagnosis. The misdiagnosis results in inappropriate/ineffective treatment and recurrence of the sinus tract. We present a 19-year-old woman who presented to the ENT outpatient department with episodic discharge from a long-standing fistula anterior to the left sternomastoid muscle. This was associated with repeated episodes of ipsilateral tonsillitis. In relation to the history and because of the position of the fistula, a diagnosis of second branchial arch fistula was made. An attempt at excision was unfortunately followed by early recurrence of discharge. At review following the procedure, a defect of the left tympanic membrane in the form of a fibrous band was noted, and a revised diagnosis of first branchial arch sinus was made. Wide surgical excision of the tract with partial parotidectomy was performed. An uneventful postoperative course followed, with no recurrence of symptoms after 24 months of review. We discuss the case, the diagnostic pathway, and the wide local excision technique used for removal of branchial fistulae.
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Mirilas P. Lateral Congenital Anomalies of the Pharyngeal Apparatus: Part III. Cadaveric Representation of the Course of Second and Third Cleft and Pouch Fistulas. Am Surg 2011. [DOI: 10.1177/000313481107700939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
“Stepladder” surgery for fistula from second or third pharyngeal cleft and pouch is “blind.” Neither intraoperative methylene blue injection and probing nor preoperative imaging (fistulo-gram ultrasound, computed tomography, magnetic resonance imaging) reveal three-dimensional anatomic relations of fistulas. This article describes the most common second and third fistula courses and demonstrates representation of their tracts with wires in human cadavers. A second cleft and pouch fistula, at its external opening, pierces superficial cervical fascia (and platysma), then investing cervical fascia, and travels under the sternocleidomastoid muscle, superficial to the sternohyoid and anterior belly of omohyoid. It ascends along the carotid sheath, and at the upper border of the thyroid cartilage it pierces the pretracheal fascia. Characteristically, it courses between the carotid bifurcation and over the hypoglossal nerve. After passing beneath the posterior belly of the digastric muscle and the stylohyoid, it hooks around both glossopharyngeal nerve and stylopharyngeus muscle. The fistula reaches the pharynx below the superior constrictor muscle. The course of a third cleft and pouch fistula is similar until it has pierced pretracheal fascia; then it passes over the hypoglossal nerve and behind the internal carotid, finally descending parallel to the superior laryngeal nerve, reaching the thyrohyoid membrane cranial to the nerve.
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Affiliation(s)
- Petros Mirilas
- Centers for Surgical Anatomy and Technique, Emory University School of Medicine, Atlanta, Georgia
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23
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Stripping of a fistula for complete second branchial cleft. J Plast Reconstr Aesthet Surg 2010; 63:1052-4. [DOI: 10.1016/j.bjps.2009.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Revised: 10/30/2009] [Accepted: 11/06/2009] [Indexed: 11/23/2022]
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Magnetic resonance imaging of branchial cleft abnormalities: illustrated cases and literature review. The Journal of Laryngology & Otology 2009; 124:213-5. [DOI: 10.1017/s0022215109990995] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:We report two cases of branchial cleft abnormalities investigated using magnetic resonance imaging.Background:There appears to be no clear imaging technique that is universally recommended for imaging branchial cleft abnormalities. Options include fistulography, computed tomography, magnetic resonance imaging and ultrasonography.Method:Case reports and literature review.Case reports:Two cases, although not unusual in themselves, are described to illustrate the use of magnetic resonance imaging to define the anatomy and to assist surgical planning.Conclusion:Magnetic resonance imaging is able to accurately depict the extent and course of branchial cleft abnormalities, and in the current cases could have been relied upon to determine the necessary surgical procedure. Branchial cleft abnormalities are sufficiently rare for magnetic resonance imaging to be recommended as the first-line imaging modality.
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Guarisco JL, Fatakia A. Intraoperative fistulograms in the management of branchial apparatus abnormalities in children. Int J Pediatr Otorhinolaryngol 2008; 72:1777-82. [PMID: 18835647 DOI: 10.1016/j.ijporl.2008.08.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 08/12/2008] [Accepted: 08/15/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We sought to evaluate the role and efficacy of intraoperative fistulograms in visualizing branchial apparatus (fistula/sinus) abnormalities in the pediatric age group (3 months-12 years). METHODS This was a retrospective analysis of 20 pediatric patients who underwent fistula and/or sinus excision during a period of 18 years (1988-2006). RESULTS The male:female ratio was 11:9. Eighteen of the 20 patients presented with unilateral abnormalities, 2 with bilateral abnormalities. An intraoperative fistulogram was utilized in every instance. The fistulogram clearly differentiated the sinus tracts from complete fistulas in all cases. It was also highly useful in delineating the exact length and course of the sinus/fistula tracts. CONCLUSIONS Intraoperative fistulograms are easy to do in the operating room on the day of the scheduled surgery. They are a very useful tool in the management of branchial apparatus abnormalities.
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Affiliation(s)
- J Lindhe Guarisco
- Department of Otolaryngology, Ochsner Clinic Foundation, 1514 Jefferson Highway, Jefferson, LA 70121, United States.
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