First cleft branchial fistula in a child – a modified surgical technique

Abstract

Congenital first branchial cleft fistulae, their embryology, anomalies, varied relationships to the facial nerve and surgical techniques for their excision have been well described in the literature. We report a case of a type II first cleft fistula in a three-year-old child which required a modification of the standard surgical approach to achieve safe and complete excision with identification and preservation of the facial nerve.

Branchial cysts within the parotid salivary gland

“…Hence excisional biopsy by superficial parotidectomy is the standard diagnostic and therapeutic intervention for such cysts [ 45 ]. If the diagnosis of a parotid branchial cyst is certain, then simple partial lateral superficial parotidectomy with preservation of the facial nerve is recommended, perhaps via a modified retroauricular incision [ 22 ]. Otherwise, a formal superficial parotidectomy with intraoperative facial nerve monitoring should be undertaken to prevent inadequate excision of a tumour and recurrence of the branchial cyst [ 6 , 7 , 24 - 26 ].…”

“…A benign parotid tumour is the commonest clinical diagnosis of a parotid mass, which results in superficial parotidectomy with general complete surgical excision and little recurrence [ 17 ]. When the nature of the swelling has been predetermined, careful enucleation of the cyst has been successfully performed [ 22 ].…”

Type II First Branchial Cleft Cyst Presenting as Parotid Mass: A Case Report

“…They duplicate both the EAC and auricular elements, and thereby contain cartilage [1]. A complete type II tract frequently pierces the parotid gland, often tracking medial to the facial nerve on its way to the bony-cartilaginous junction or middle ear [2].…”

The diagnosis of a cervical tumefaction in children

“…The treatment is surgical. For a complete excision, especially in type II, it is recommended an exploratory parotidectomy with dissection of the facial nerve and complete excision of the fistulous tract, in order to avoid relapse 9,10,16 .…”