Resection of recurrent third branchial cleft fistulas assisted by flexible pharyngotomy

Abstract

BACKGROUNDTreatment of fistulas arising from the third branchial cleft includes endoscopic cauterization or open cervical fistulectomy. Both approaches are associated with recurrence rates of 14%-18%, and possibly greater rates when the fistula has been treated operatively beforehand. Treatment of fistulas arising from the third branchial cleft is associated with an inordinate recurrence rate. Recurrence may be multifactorial and related to incomplete resection of all of the anatomical elements of the fistula.AIMTo present a new approach that involves complete resection of the recurrent fistula by a combined therapeutic approach.METHODSHere, 12 adult patients diagnosed with recurrent third branchial cleft fistulas underwent a combined therapy assisted by flexible fiber-optic pharyngoscopy to identify and resect the entry site of the fistula into the pyriform sinus. The fistulous opening into the pyriform sinus was identified by flexible fiber-optic pharyngoscopy. The application of intubation with a guidewire by pharyngoscopy, in addition to the removal of the partial excision of the thyroid cartilage, allowed complete resection of the opening and all parts of the fistula tract.RESULTSAll of the internal openings of the fistulas in the pharynx were found and easily identified by flexible fiber-optic pharyngoscopy. All of the 12 patients underwent complete resection of the recurrent fistula by the combined therapeutic approach. There were no postoperative complications such as parapharyngeal abscess or wound infection, injury or dysfunction of the recurrent laryngeal or superior laryngeal nerves. The pharyngeal edema had degraded, and the pharyngeal wound healed postoperatively within 1 wk. Laryngeal endoscopy and voice analysis were performed on the 14th d post-operatively. Vocal cord movements did not change. The characters of voice for jitter, shimmer, and normalized noise energy were all within normal limits. In addition, no recurrences were observed during the 13-60 mo follow-up period.CONCLUSIONIt can be concluded that the proposed combined therapy is associated with excellent results, minimal morbidity, and no recurrence.

A safe and effective surgical method for complex pyriform sinus fistula

“… 1 , 46 However, it is difficult to identify the fistula structure during surgery, which makes it difficult to resect completely. 5 In addition, some scholars advocate the use of some materials (such as zebra guidewire) to identify the location of the fistula during the operation, 47 but its use is limited, and the guidewire needs to be removed after the fistula is removed, which increases the complexity of the surgical procedure. Based on this, we advocate a new surgical procedure to treat pyriform sinus fistula, especially for complex fistulas.…”