Branchial Cleft Fistulas
A branchial cleft abnormality is due to the mass of abnormally formed tissues within the neck. These tissues may form pockets called cysts that contain fluid, or they may form passages that drain to an opening in the skin surface. Branchial cysts are more common in older adolescents and adults, especially males, while branchial fistulas are more commonly seen in young infants. A congenital, abnormal tract connecting the skin of neck with an internal structure, resulting from failure of closure of a branchial cleft. Branchial cleft abnormalities are usually located near the front edge of the sternocleidomastoid muscle, which is the neck muscle that extends from the jawbone (mastoid) to the clavicle (collarbone) and sternum (breastbone).
Cause of Branchial Cleft Fistulas
Some causes are follows :
- Branchial cleft cysts are lined with skin and lymph cells and contain fluid that is secreted by these cells.
- Branchial cleft fistulas also contain skin cells but drain mucus and fluids from other internal areas of the neck and throat.
- A branchial cleft abnormality is a congenital (present from birth) defect that occurs during early embryonic development when the structures and tissues that form the neck and throat do not properly grow together.
- Branchial cleft contributes to the tympanic cavity and eustachian tube. Related fistulae are very rare and tend to be infra- or retroauricular. (Preauricular cysts and sinuses are not thought to be of branchial cleft origin.)
- The branchial cleft forms the hyoid bone and tonsillar fossa. Related fistulae (most common variant) course between the internal and external carotid arteries. Internal opening usually at level of tonsillar fossa. External opening along anterior border of sternocleidomastoid muscle.
Syptoms of Branchial Cleft Fistulas
Common symptoms of Branchial Cleft Fistulas :
- Small lump or mass to the side of the neck near the front edge of the sternocleidomastoid muscle (usually only on one side of the neck, rarely on both sides; usually painless unless infected)
- Small opening in the skin that drains mucus or fluid near the front edge of the sternocleidomastoid muscle .
- Branchio-Oto-Renal Syndrome is an autosomal, dominant disorder.
- The branchial manifestations are usually inconsequential; however, the hearing impairment and renal malformations can be significant.
- Spontaneous mucoid drainage
- External openings may also be marked by a skin tag or cartilage
- Infection may rarely be the presenting sign with erythema, swelling, pain, fever
- 10% are bilateral
Treatment of Branchial Cleft Fistulas
Effective treatment tips for Branchial Cleft Fistulas :
- Surgery is indicated for branchial anomalies because there is a lack of spontaneous regression, a high rate of recurrent infection, the possibility of other diagnoses, and rare malignant degeneration.
- Your child's age, overall health, and medical history
- Extent of the condition
- Your child's tolerance for specific medications, procedures, or therapies
- Expectations for the course of the condition
- Your opinion or preference
- Functional neck dissection is suitable for treatment of recurrent cervical branchial defects.
- The standard surgery for second arch anomaly is usually by a stepladder incision originally described by Bailey in 1933.
- Visualization of the tract at operation may be aided by injecting into the fistula paraffin, methylene-blue dye or quick-hardening polymers. The dissection may be facilitated by prior catheterization of the fistula.