Second branchial cleft fistula/sinus tract endoscopy: a novel intraoperative technique assisting complete surgical resection

Congenital second branchial cleft anomalies in children: A report of 52 surgical cases, with emphasis on characteristic CT findings

“…BCAs are the second most common pediatric head and neck congenital lesions, accounting for approximately 30% of congenital neck disease (1,16). The most widely accepted theory is that the BCAs result from incomplete obliteration of branchial pouches and clefts during embryogenesis (1,8). Of these, CSBCAs are the most common, making up 90%-95% of all BCAs (1, 2, 5, 13).…”

“…CSBCAs were classified into the following four subtypes on the basis of the Bailey classification: (i) the most superficial subtype, which reached as deep as the platysma surface and lies along the anterior surface of the SCM, but not in contact with the carotid sheath (Figure 1); (ii) the most common subtype, identified anterior to the SCM, posterior to the SMG, and lateral to the carotid sheath (Figure 2); (iii) extended medially between the bifurcation of the external and internal carotid arteries, lateral to the pharyngeal wall (Figure 3); and (iv) arose in the pharyngeal mucosal space and opened into the pharynx (1,3,7,8,14) (Figure 4).…”

“…Because first, third, and fourth BCAs are rare, congenital second branchial cleft anomalies (CSBCAs) make up 85%-95% of all BCAs (1,2,5). CSBCAs may present as fistulas, cysts, or sinuses, and they usually present with nonspecific symptoms, including discharge from the skin opening, neck swelling, or recurrent infections (6)(7)(8). The lesions of CSBCAs may vary significantly from being short extending just up to the surface of sternocleidomastoid muscle (SCM), or up to carotid sheath, to a longer tract extending through carotid bifurcation up to pharyngeal constrictor muscles, or to the palatine tonsil (3,8).…”

“…Success primarily depends on accurate definition and meticulous surgical resection of the tract, which can be sometimes challenging, particularly in multiply infected cases (9). Clinically, the CSBCAs are often misdiagnosed and need to be differentiated from TGDC, congenital first branchial cleft anomaly (CFBCAs), congenital pyriform sinus fistula (CPSF), lymphatic malformations (LMs), and other cystic neck lesions (1,8). The above diseases have certain characteristic clinical and imaging appearances, and familiarity which can assist in clinical diagnosis (2,10,11).…”

Branchial Cleft Anomalies: Embryogenesis, Clinical Features, Diagnosis, and Management

“…56 Guerrissi 57 was the first to describe this technique and demonstrated excellent visualization of a second BCA fistulous tract through a minimal skin incision. Magdy et al 58 demonstrated similar success using intraluminal endoscopy to facilitate visualization of the fistula, while Rassekh et al 59 describe the resection of the pharyngeal component of a BCA fistula using a robotic-assisted minimally invasive approach. Sclerotherapy using OK-432 and various chemocauterization techniques have also been described but carry a risk of collateral injury to surrounding structures.…”