Early presentation of complete branchial fistula with review of literature
Keywords:Branchial fistula, Step ladder incision, Sternomastoid muscle
Branchial anomalies are rarely seen in clinical practice. They arise as a result of aberrations of the branchial apparatus during fetal development. Though present since birth, they are usually diagnosed in the first or second decade of life. Second arch anomalies are by far the most common and present as a neck mass or discharging sinus that may be complicated by infection. Clinical examination often reveals the lesion to be related to the junction of the upper two thirds and the lower one third of the sternocleidomastoid muscle. Branchial fistulas often present as a discharging sinus in the neck. The fistulous tract may extend for a variable distance within the neck. However complete branchial fistula of the second cleft with an internal opening in the tonsillar area and an external opening in the skin is rare. Surgical excision using the step ladder approach was used. No recurrence was seen at one year follow up. The incidence of such lesions presenting within first two years of age is extremely rare. Surgical excision is the treatment of choice for branchial anomalies. We present the case of a two-year-old female patient with complete branchial fistula and discuss the clinical presentation and surgical management of such lesions, while reviewing the relevant literature.
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