Abstract
BackgroundSecond 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.MethodsWe 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.ResultsOf 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.ConclusionEffective 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.
Highlights
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
Given that these patients are at risk for recurrent infection that may lead to abscess formation, definitive management consists of complete surgical excision of the fistula tract
We have previously published findings of our experience with 28 patients undergoing surgery for second branchial cleft fistulae, demonstrating no recurrent disease using a surgical technique that employs the hyoid bone as a landmark [5]. In this follow up study, we present 67 cases of second branchial cleft fistulae excision, the largest cohort performed by a single center with a uniform technique reported in the medical literature and compare our findings with those of prior studies
Summary
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. Branchial cleft anomalies are formed due to failure of embryonic structures to obliterate during development These anomalies are the second most common pediatric congenital head and neck masses, accounting for approximately 20% of cases [1]. Patients with fistulae often present with mucoid drainage from a lateral neck opening that may become infected over time. Given that these patients are at risk for recurrent infection that may lead to abscess formation, definitive management consists of complete surgical excision of the fistula tract. Some authors have recommended excision of the fistulous tract, and ipsilateral tonsillectomy given that the tract terminates
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