Presentation
Persistent discharge on the anterior neck
Patient Data
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.
Loading images...
There is 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.
Loading images...
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.
Loading images...
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.
Unable to process the form. Check for errors and try again.