A rare case of second branchial fistula with two external openings

Abstract

Branchial apparatus was first described by Von Baer, but Von Ascheron was the one who described the anomalies in its development. The branchial cyst, sinus and fistula are anomalies of the branchial apparatus which consists of five mesodermal arches separated by invagination of ectoderm (clefts) and endoderm (pouch). Here we present a case of bilobulated second branchial fistula which had both openings over the skin of right anterolateral aspect of the neck. A seven years old girl, presented to ENT OPD, complaining of swelling on right side of the neck associated with discharge from an opening over the swelling since birth. The swelling was painless, progressively increasing in size. Her mother revealed that she had occasionally had a clear discharge from the openings since birth. On examination, dumbbell shaped cystic swelling approx. 5×2 cm in size with two pinhead openings on both the ends, noticed along the anterior border of SCM over the middle third of the neck. Radiological and histopathological investigations confirmed the diagnosis of second branchial fistula. Patient was managed with complete surgical excision. Second branchial anomalies present along the anterior border of sternocleidomastoid. Fistulous tract commonly extends into the pharynx, most commonly in the region of tonsillar fossa. This case report describes a congenital anomaly for which the definitive treatment was surgery. Unlike, other complete second branchial fistula it had two external openings and it was a bilobulated tract, which makes this case a rare variety of branchial fistula