From the Research
The surgery to address a branchial cleft fistula is complete surgical excision of the entire fistulous tract, which can be facilitated by intraoperative endoscopy to accurately assess the anomaly extension and assist in complete surgical excision, as described in the most recent study 1. This procedure involves making an incision in the neck, carefully identifying the fistula tract, and removing it completely from its external opening on the neck to its internal connection, which may extend to the pharynx or tonsillar region. The surgery is typically performed under general anesthesia and requires meticulous dissection to follow the tract through its often tortuous path. Complete excision is essential because partial removal can lead to recurrence, as highlighted in a case report of a recurrent first branchial cleft fistula with cysts 2. The surgeon must identify important structures like the carotid artery, jugular vein, and cranial nerves to avoid injury during dissection. For second branchial cleft fistulas (the most common type), a step-ladder approach with multiple incisions may be necessary to follow the tract as it passes between the carotid vessels, as described in a study on the diagnosis and surgical management of complete branchial cleft fistula 3. Some key points to consider in the surgical management of branchial cleft fistulas include:
- The use of intraoperative endoscopy to assess the anomaly extension and assist in complete surgical excision 1
- The importance of complete excision to prevent recurrence, as highlighted in a study on the clinical manifestations, diagnosis, and management of first branchial cleft fistula/sinus 4
- The need for meticulous dissection to avoid injury to important structures like the carotid artery, jugular vein, and cranial nerves
- The potential for a step-ladder approach with multiple incisions to be necessary for second branchial cleft fistulas Recovery typically takes 1-2 weeks, with potential complications including wound infection, hematoma, nerve injury, or recurrence if any portion of the tract remains. Surgery is the definitive treatment as these congenital anomalies do not resolve spontaneously and can become repeatedly infected if left untreated, as noted in a study on the management of recurrent first branchial cleft fistula with cysts 2.