First branchial arch fistula: diagnostic dilemma and improvised surgical management

• Published in: American journal of otolaryngology Vol. 32; no. 6; pp. 617 - 619
• Main Authors: Prabhu, Vinod, MBBS, MRCS, DLO, DOHNS, Ingrams, Duncan, FRCS (ORL-HNS)
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2011; Elsevier; Elsevier Limited
• Subjects: Biological and medical sciences; Branchial Region - abnormalities; Branchial Region - pathology; Branchial Region - surgery; Branchioma - diagnosis; Branchioma - surgery; Cysts; Ear Canal - pathology; Ear Canal - surgery; Female; Follow-Up Studies; Head and Neck Neoplasms - diagnosis; Head and Neck Neoplasms - surgery; Humans; Medical sciences; Otolaryngology; Otorhinolaryngologic Surgical Procedures - adverse effects; Otorhinolaryngologic Surgical Procedures - methods; Otorhinolaryngology. Stomatology; Parotid Gland - surgery; Postoperative period; Recurrence; Reoperation - methods; Sinuses; Surgery; Tonsillectomy - methods; Tonsillitis; Treatment Outcome; Tympanic Membrane - pathology; Tympanic Membrane - surgery; Young Adult; Fistula; ENT; Treatment; Diagnosis; Surgery; Branchial arch
• ISSN: 0196-0709; 1532-818X
• DOI: 10.1016/j.amjoto.2010.09.008

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.