First branchial cleft fistula (Work Type 2) with an internal opening to the Eustachian tube: Case report and review of literature

Abstract

First branchial cleft anomalies are rare congenital defects of the head and neck. This case report presents a 12-year-old patient with a draining cutaneous pit approximately 1-cm anterior and 5-mm inferior to the right angle of the mandible. Imaging revealed a fistula between the cutaneous pit and Eustachian tube. Further characterization with methylene blue injection into the cutaneous pit resulted in spillage through the right Eustachian tube. Surgical excision of the fistula revealed a cylindrical structure comprised of ectodermal and mesodermal features that most likely represented a Work Type 2 first branchial cleft fistula.

Type-I Branchial Cleft Fistula, A Rare Incidence: Treated with Surgical Excision

“…Understanding the development of the head and neck is important because the branchial pouches and arches can be used by medical practitioners to pinpoint the location and origin of certain problems. The branchial arches and clefts, which are the embryologic predecessors to many head and neck structures, start to form around 4-5 weeks of pregnancy [9]. The most common branchial cleft anomaly is caused by the second branchial arch, which accounts for nearly 95% of all defects, followed by the first arch, which accounts for less than 6% of all defects.…”

First branchial cleft fistula: a case report and literature review

“…Additionally, it is the precursor of the formation of the maxilla that arises from the first arch, and the first pharyngeal pouch forms the middle ear, eustachian tube, and the mastoid antrum. During the sixth gestation, these arches start to merge and disappear; however, in some rare cases, the first branchial arch will not completely disappear [3], thus, resulting in the first branchial cleft anomaly. Branchial cleft cysts, fistulas, and sinuses may occur in any age group, but the first and second decades of life are the most common [4].…”