Second branchial cleft fistula

Case contributed by Dr Subash Thapa

Presentation

5 year girl with persistent discharge on the anterior neck

Patient Data

Age: 5 years
Gender: Female
Modality: Photo

There is an external cutaneous orifice on the anterior aspect of the neck just below the thyroid cartilage, anterior to medial border of the lower third of the right sternocleidomastoid muscle.

There is no discharge from the orifice at the time of examination.

There is no change in position of the external orifice on protrusion of tongue or swallowing.

Modality: X-ray

Under all aseptic condition about 7ml of non-ionic water soluble iodinated contrast media was injected into the external orifice via a plastic canula which outlined an irregular tract measuring 5.4 cm extending cranially upto the right palatine tonsillar region.

Modality: Ultrasound

Sagittal and Coronal CT images show an irregular tract with the external orifice at the right lateral aspect of the neck just below the thyroid cartilage which is extending to the right palatine tonsillar region.

Modality: CT

Sagittal and Coronal CT images show an irregular tract with the external orifice at the right lateral aspect of the neck just below the thyroid cartilage which is extending to the right palatine tonsillar region.

Case Discussion

Branchial fistula represent a persistent second branchial cleft where the external cutaneous orifice is nearly always situated in the lower third of the neck near the sternocleidomastoid, whilst the internal orifice is located on the anterior aspect of the posterior faucial pillar just behind the tonsil. The tract is lined by the ciliated columnar epithelial 1.

Branchial cleft fistula should be differentiated from thyroglossal fistula which arise from epithelial trapped during the embryonic descent of the thyroid gland as is located in the midline between base of the tongue and the thyroid. The external orifice of the thyroglossal fistula moves on tongue protrusion 1.

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Case Information

rID: 40934
Case created: 8th Nov 2015
Last edited: 13th Nov 2015
System: Head & Neck
Inclusion in quiz mode: Included

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