Liu H, Cheng A, Ward BB, Wang C, Han Z, Feng Z. First branchial cleft fistula (Work Type 2) with an internal opening to the Eustachian tube: Case report and review of literature. Faruque O, Wischhusen JD, Reckley LK, Rooks VJ, Liming BJ. Incision and drainage and antibiotics therapy can be considered, however, there is a high rate of recurrence associated 1,2. Given the intimacy of the tract with the facial nerve, surgery can be complicated by temporary or permanent facial nerve palsy 1-3. Surgical excision of the entire fistulous tract is the only definitive treatment 1-3. However, Ultrasound and CT fistulography are more widely used. MRI provides a high degree of soft-tissue resolution and can be used to define lesions 2. Hence it is often used clinically to assist in surgical planning 3,4. CTĬT, particularly used in conjunction with fistulography offers excellent anatomical visualization of the fistulous tract 1,3,4. The fistulous tract can be effectively demonstrated on ultrasound as an anechoic linear structure 2. The tract can pass superficially or deep to the facial nerve and parotid gland 1-6. The tract is often smooth with a variable diameter, extending from the external cutaneous opening to its junction with the external auditory canal 1-4. course medial to facial nerve and often inferior to the angle of the mandibleĬontrast injected into the cutaneous dimple allows for delineation of the course of the fistulous tract which provides great value in surgical planning 1-4.histologically include squamous epithelium, cartilage and adnexal structures.arises from the duplication of membranous and cartilaginous external auditory canal.originates from the ectoderm and mesoderm.course lateral to facial nerve and parotid gland.histologically cystic and consists of squamous epithelium.arises from the duplication of membranous external auditory canal.Classificationsīranchial cleft anomalies can be classified based on embryology and histology using Work’s classification 1-3,5,6: Specifically, first branchial cleft fistulae arise from incomplete obliteration of clefts secondary to incomplete fusion of the ventral portion of the first and second branchial arches 1-4. The embryology of the branchial apparatus is complex and associated with various malformations further described in branchial cleft anomalies. The cutaneous opening can usually be found anywhere on the lateral neck below the external auditory canal, above the hyoid bone, anterior to the sternocleidomastoid muscle and posterior to the submandibular angle 2. Patients with first branchial cleft fistulae typically complain of a mass or recurrent mucopurulent discharge from a cutaneous pit 1,3-5. 52% of first branchial cleft anomalies manifest as fistulae and they have been reported to occur more frequently on the left side (64%) 3. These patients typically present in the first two decades of life 5. It occurs twice as frequently in females than in males 3. The annual incidence has been estimated to be 1 per million live births 1-4. Anomalies of the first branchial cleft make up less than 8% of all branchial cleft anomalies 1-3,6.
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