Definitive surgical management for second branchial cleft fistula: A case series

Abhita Reddy*, Taher Valika, John Maddalozzo

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Second branchial cleft fistulae are rare pediatric anomalies managed with surgical excision and, in certain cases, ipsilateral tonsillectomy to prevent postoperative recurrence or wound infection. Limited information is available in the published literature regarding surgical techniques to maximize patient outcomes and minimize recurrence. Our objective was to describe outcomes for the largest series of branchial cleft fistulae excised using a uniform technique based on embryologic principles. Methods: We conducted a retrospective analysis of pediatric patients who underwent surgery for second branchial cleft fistula using a uniform technique developed by the senior surgeon between 2006 and 2018 at a tertiary care pediatric hospital. The technique involves dissection to the level of the greater cornu of the hyoid bone as the point of transection, which is the landmark for the base of the tonsillar fossa. Data collected included age at surgery, initial presentation, laterality of fistula tract, final pathology, and follow up data. Measured outcomes included fistula recurrence, wound infection, and other complications. Results: Of 67 patients, 28 (42%) were male and 10 (15%) had bilateral fistulae, for a total of 77 tracts excised. After a median follow up of 31 months, there were no recurrences and one wound infection that was treated successfully with oral antibiotic therapy. No patients underwent tonsillectomy. Conclusion: Effective management of second branchial cleft fistulae can be challenging. We present the largest cohort of results using a uniform surgical technique performed at a single center that obviates the need for tonsillectomy, and thus represents a less morbid and effective approach with no evidence of recurrence.

Original languageEnglish (US)
Article number55
JournalJournal of Otolaryngology - Head and Neck Surgery
Volume49
Issue number1
DOIs
StatePublished - Aug 5 2020

Keywords

  • Congenital neck mass
  • Pediatric head and neck surgery
  • Second branchial cleft fistula

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

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