Collaural fistula (Work Type II first branchial cleft anomaly) with prolonged morbidity: A case report

Collaural fistula is a very rare Work Type II first branchial cleft anomaly in which there is a complete fistulous tract between external auditory canal and the neck. Misdiagnosis and mismanagement can lead to prolonged morbidity and complications due to repeated infections. We present a case of an 18-year-old lady with a recurrent discharging sinus on her neck for 4 years. She has been treated with repeated incision and drainage and multiple antibiotics in the past. Otoscopic examination revealed an opening on the floor of the left external auditory canal. A diagnosis of an infected collaural fistula was made. Complete excision of the fistulous tract was done after treatment of the active infection. On follow-up, there was no further recurrence at 1 year. Sound knowledge of embryology of branchial anomalies with good history and examination is important to make correct and early diagnosis to prevent morbidity.

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Anomalies of branchial cleft: our experience and review of literature

International Surgery Journal ◽

10.18203/2349-2902.isj20174108 ◽

2017 ◽

Vol 4 (10) ◽

pp. 3234

Author(s):

Neha Sisodiya Shenoy ◽

Charu Tiwari ◽

Suraj Gandhi ◽

Pankaj Dwivedi ◽

Hemanshi Shah

Keyword(s):

Clinical Presentation ◽

Abnormal Development ◽

Review Of Literature ◽

Complete Excision ◽

Duration Of Symptoms ◽

Incision And Drainage ◽

Branchial Arches ◽

Branchial Cleft ◽

Definitive Surgery

Background: Anomalies of branchial arches are uncommon anomalies of embryonic development and may present as cysts, sinus tracts, fistulae or cartilaginous remnants. We describe our experience with 30 children with branchial cleft anomalies.Methods: Case records of all patients were retrospectively reviewed and analysed with respect to age, sex, clinical presentation, duration of symptoms, investigations, management and follow up. All patients underwent complete excision of the tract/cyst.Results: There were 15 males and 15 females (ratio of 1:1). The average age of presentation was 5 years. Majority of the patients presented with discharging sinuses (n=26). Twenty-six patients had branchial sinuses, three patients had branchial cysts and one had pyriform fistula. The anomalies were lateralized to left side in 17 patients (56.66%), right side in 11 patients (36.66%) and bilateral in 2 patients (0.066%). Complete excision was done in all patients. Four patients presented with abscesses and required incision and drainage. Definitive surgery was done after 6 weeks. There were no complications.Conclusions: Abnormal development of branchial apparatus lead to formation of different anomalies which remain asymptomatic and present later in life as cysts, sinuses or fistulae in neck. Diagnosis is mostly clinical and complete excision provides definitive cure.

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Work Type II First Branchial Cleft Cyst with External Auditory Canal Duplication

The Laryngoscope ◽

10.1002/lary.20310 ◽

2009 ◽

Vol 119 (S1) ◽

pp. S17-S17

Author(s):

Sandy Mong ◽

Anthony Nichols ◽

Daniel G. Deschler

Keyword(s):

External Auditory Canal ◽

Type Ii ◽

Branchial Cleft Cyst ◽

Branchial Cleft ◽

Work Type

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First branchial cleft fistula: a case report

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20203219 ◽

2020 ◽

Vol 6 (8) ◽

pp. 1568

Author(s):

Rupa Mehta ◽

Ankit Mishra ◽

Nitin M. Nagarkar ◽

Vandita Singh

Keyword(s):

Facial Nerve ◽

External Auditory Canal ◽

Fistulous Tract ◽

Clinical Signs ◽

Signs And Symptoms ◽

Cervical Region ◽

Lateral Part ◽

Complete Excision ◽

Nerve Preservation ◽

Branchial Cleft

First branchial cleft anomalies (BCA) are a rare finding in head and neck with incidence nearly- incidence of nearly 1 million per year which are distributed below external auditory canal, above the hyoid bone, anterior to sternocleidomastoid and posterior to submandibular triangle. First branchial cleft cysts are frequently misdiagnosed as they are rare and pose unfamiliar clinical signs and symptoms. Here we are reporting a case of surgical management of 1st branchial cleft fistula in a 5 years old male child from AIIMS, Raipur, Chhattisgarh, India as it’s a rare entity. Child presented with discharge from right upper part of neck. There was a swelling in right upper lateral part of neck with an opening also in floor of right external auditory canal (EAC). Contrast enhanced computed tomography of neck showed a 4.8 cm long obliquely oriented fistulous tract opening at junction of middle and upper one third of sternocleidomastoid with opening in right EAC. Surgical excision of the fistulous tract was done with preservation of facial nerve. Histopathology examination confirmed the presence of fistula. Common clinical presentation of BCAs is pre-auricular swelling (24%), parotid swelling (36%) or cervical region swelling (41%). In our case, it was a fistulous opening that presented as discharging tract in upper neck. Management include early diagnosis, control of infection and complete excision with facial nerve preservation Surgical approach should be based on the clinical examination, imaging and clinical course; and there is a need to safely identify and preserve facial nerve in almost all cases.

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First Branchial Cleft Anomalies: Rare Work Type I and Type II Entities

Ear Nose & Throat Journal ◽

10.1177/01455613211015737 ◽

2021 ◽

pp. 014556132110157

Author(s):

Konstantinos Tarazis ◽

Konstantinos Garefis ◽

Maria Garefi ◽

Vasilios Nikolaidis ◽

Angelos Chatziavramidis ◽

...

Keyword(s):

Parotid Gland ◽

Type I ◽

Type Ii ◽

Branchial Cleft Anomalies ◽

Branchial Cleft ◽

Branchial Anomalies ◽

Work Type

First branchial cleft anomalies (FBCAs) are the most infrequent malformations that occur during the development of the branchial apparatus, appearing in less than 8% of all branchial anomalies. Traditionally, they are classified into Work type I and II, depending on their origin. We present a pair of rare FBCAs: a case of a preauricular Work type I cyst with twin fistulae coursing toward the parotid gland and a Work type II cyst of significant dimensions.

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A Case of Pyriform Sinus Fistula with Respiratory Distress in the Neonatal Period

Case Reports in Otolaryngology ◽

10.1155/2018/1696875 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Noriko Hamaguchi ◽

Hajime Ishinaga ◽

Kazuki Chiyonobu ◽

Hiroyuki Morishita ◽

Kazuhiko Takeuchi

Keyword(s):

Respiratory Distress ◽

Neonatal Period ◽

Fistulous Tract ◽

Pyriform Sinus ◽

Computed Tomography Imaging ◽

Pharyngeal Wall ◽

Tomography Imaging ◽

Pyriform Sinus Fistula ◽

Branchial Cleft

Pyriform sinus fistula (PSF) is an anomaly that can arise due to failure of involution of the third or fourth branchial cleft during embryogenesis. It can manifest clinically as sinuses, cysts, or abscesses in the neck and is common in childhood. Herein, we describe a neonate who presented with neck swelling and respiratory distress, which was secondary to a fourth branchial pouch sinus. Physical examination revealed swollen areas in the posterolateral pharyngeal wall and on the external left side of the neck. Computed tomography imaging showed a left-sided mass that was filled with air and fluid. Eventually, the pyriform sinus cyst and the entire fistulous tract were excised. The postoperative course was uneventful. Follow-up after 18 months showed no recurrence.

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Endoscopic Management of Recurrent Third Branchial Fistula using Histoacryl Glue

APSP Journal of Case Reports ◽

10.21699/ajcr.v9i1.650 ◽

2018 ◽

Vol 9 (1) ◽

pp. 2

Author(s):

M Z Naveed ◽

A Naveed ◽

A Irfanullah

Keyword(s):

Fistulous Tract ◽

Surgical Excision ◽

Branchial Arch ◽

Endoscopic Management ◽

Cyanoacrylate Glue ◽

Branchial Cleft Anomalies ◽

Branchial Cleft ◽

Branchial Fistula ◽

Minimally Invasive Methods

Third branchial cleft anomalies are rare accounting for 2-8% of all branchial abnormalities. We report a case of a 9 year old boy who presented with discharging sinus on the left side of neck. A sinogram revealed third branchial arch fistula. The tract was surgically removed, however, on follow up the fistula was recurred. He was later taken for endoscopic cauterization and injection of Histoacryl (n-Butyl cyanoacrylate ) glue into the tract, after which his wound healed swiftly. Historically, surgical excision of the fistulous tract has been the mainstay of treatment. Recently, minimally invasive methods are gaining wider acclaim and may potentially become the treatment of choice in the future.

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Minor vs complete excision of pilonidal sinus: Early postoperative period

Acta chirurgica iugoslavica ◽

10.2298/aci1202081p ◽

2012 ◽

Vol 59 (2) ◽

pp. 81-85 ◽

Cited By ~ 1

Author(s):

Jelena Petrovic ◽

Ivan Dimitrijevic ◽

Zoran Krivokapic

Keyword(s):

Pilonidal Sinus ◽

Pilonidal Disease ◽

Healing Time ◽

Early Postoperative Period ◽

Surgical Approaches ◽

Complete Excision ◽

Surgical Incision ◽

Natal Cleft ◽

Incision And Drainage

Pilonidal sinus arises in the natal cleft of the sacrococcigeal region either as a cyst or as an abscess collection containing hair. It is predominantly a condition of younger people. When presenting as an abscess it usually requires surgical incision and drainage, or bursts spontaneously. In general, there are various surgical approaches to this condition, from very simple to complex ones. Each technique has its supporters and justifications. In the 3 years period, from 2009-2011, 110 treatments of the pilonidal disease were performed on our department. Midline excision was performed in 75 (68.18%) patients and the rest had marsupielisation done. The average discharge time was 1.14 days. Failure to heal occurred in 15 patients (13.63%). During that period we saw recurrence in 4 patients (3.63%). All the patients were coming to our department for postoperative care. The shortest healing time was 4 weeks and longest 21 weeks. During the period may 2011-may 2012 we performed 17 less extensive excisions. All the patients were discharged from the clinic within 23 hours and returned to their daily activities within 5 days. Healing time varied from 2 weeks to 5 weeks. In only one patient with the extensive excision healing time was 8 weeks. Although we had a short follow up period of 11.11 months, we saw no recurrence yet. Our results show that simple individual approach to every patients gives fastest and most comfortable results.

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Work type II first branchial cleft cyst

Annals of Pediatric Surgery ◽

10.1097/01.xps.0000450387.21371.e2 ◽

2014 ◽

Vol 10 (3) ◽

pp. 81-82 ◽

Cited By ~ 1

Author(s):

Jenica Su-ern Yong ◽

Woei Shyang Loh ◽

Hsueh Yee Lynne Lim

Keyword(s):

Type Ii ◽

Branchial Cleft Cyst ◽

Branchial Cleft ◽

Work Type

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Second branchial cleft anomalies: a review of 12 cases

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20192733 ◽

2019 ◽

Vol 5 (4) ◽

pp. 1075

Author(s):

Niral R. Modi ◽

Jamin Anadani ◽

Sanjay M. Tota

Keyword(s):

Surgical Excision ◽

Age Group ◽

Neck Swelling ◽

Mri Scan ◽

Anterior Neck ◽

Branchial Cleft Anomalies ◽

Branchial Cleft ◽

Branchial Anomalies ◽

Age And Sex

Background: It is a combined retrospective and prospective study of 12 cases of branchial cleft anomalies presented to our hospital. We analysed them for their age and sex incidence, side prevalence, according to clinical features and treatment outcomes.Methods: Thorough history was taken and examination was done and these cases are investigated with CT scan, MRI scan and treated with surgical excision. Results: Cyst is seen in 7 (58.33%) patients while one case of sinus and one (8.33%) of fistula,1 case of co-existing sinus and fistula (8.33%), and one Bilateral sinus and 1 bilateral fistula (8.33%) were seen. Overall incidences of branchial anomalies are more (40%) in 11-15 year age group. Overall incidence of branchial anomalies is more in male (66.66%) than female (33.33%). 4 cysts were right sided and 3 were left sided. Sinus and fistula were seen one case having right sided and 1 case having bilateral anomaly. Patients having branchial cysts presents most commonly with neck swelling and pain while patients having fistula and sinus presents commonly with discharging opening over anterior neck. 1 case of recurrence found in cyst on follow up and no recurrences were seen in sinus and fistula.Conclusions: Cyst is the most common anomaly, most commonly affected age group is 11-15 years, male are more commonly affected, these anomalies are more prevalent on right side, and there are very less chances of recurrence after surgical excision.

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Unusual case of congenital fistula between external auditory canal and nasopharynx

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20211595 ◽

2021 ◽

Vol 7 (5) ◽

pp. 912

Author(s):

Manit M. Mandal ◽

Ajay J. Panchal ◽

Shanu B. Kher ◽

Harsh G. Dudhani ◽

Vidhi D. Shah

Keyword(s):

External Auditory Canal ◽

Unusual Case ◽

Fistulous Tract ◽

External Approach ◽

Extensive Search ◽

Neck Area ◽

Branchial Cleft Anomalies ◽

Branchial Cleft ◽

Congenital Fistula

Defects in the development in the neck area of the embryo result in branchial cleft anomalies. Various first branchial cleft anomalies are described in literature including preauricular sinuses, cysts and collaural fistula. In our case study, we document a very unusual case of fistula between floor of external auditory canal and nasopharynx. Such patient requires thorough evaluation and step-wise approach to treat. After clinical examination and radiological evaluation, surgically the fistula was excised in toto via external approach using Modified Blair’s incision. In our case, fistulous tract was running from external auditory canal to nasopharynx, running superior and medial to the trunk of facial nerve. No such case is found to be reported in literature after extensive search. Hence, it would be strongly advocated to keep this presentation in the differential diagnosis during evaluation. Also, it is worth mentioning and recommending that a careful radiological examination is a must before approaching for surgery.

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