Branchial fistula

Branchial fistula

1. BRANCHIAL FISTULA -Dr. Jeffrey G Ashiq

2. PATHOGENESIS Congenital lesion Due to persistant sinus bt 2 nd and 5 th brachial cleft. Opening at the lower inner margin of the sternocledomastoid . Internal opening – proximal to the posterior pillar of fauces behind tonsil.

3. Runs between 2 nd and 3 rd brachial arch s tructures. Runs bt ECA and ICA. Pierces the superior constrictor. May be due to rupture or incomplete excision of the B.cyst .

4. CLINICAL FEATURES Often bilateral Equal in both sexes Children and early adolescent Ant lower margin of SCM Posterior pillar Dimple – prominent on dysphagia – tuck Discharge Ciliated columnar epithelium

5. INVESTIGATIONS Fistulogram CT/MR fistulogram Discharge study

6. TREATMENT Always surgery Methylene blue – probe – tract dissected untill internal opening. Entire tract excised Stepladder dissection (two parallel incisions)