SURGICAL EXCISION OF A CONGENITAL RIGHT BRANCHIAL FISTULA IN A 12-YEAR-OLD BOY

Abstract

Branchial cleft anomalies are congenital defects arising from incomplete obliteration of the branchial apparatus during embryogenesis, and the second cleft accounts for the large majority of cases. We report the case of a 12 year-old boy with a five-year history of a right-sided neck fistula, who presented with a low-grade odynophagia and no active discharge at the time of assessment. Videolaryngoscopy confirmed a normal airway with no laryngopharyngeal abnormality, and contrast-enhanced MRI with MR angiography confirmed a right Type IV branchial cleft fistula extending from the pharyngeal mucosa at the C3 level to a cutaneous opening at C7. He underwent elective open excision of the fistulous tract under general anaesthesia, with the tract traced in the subplatysmal plane to the hyoid and further dissected to its termination medial to the carotid sheath, below the right submandibular gland, where it was ligated flush with the pharyngeal mucosa. Histopathology confirmed a benign branchial cleft cyst with no atypia. The intraoperative and immediate postoperative course was uneventful. This report describes the clinical presentation, imaging, operative technique, and relevant literature on management of branchial fistulae in children.