Abstract
Purpose
Second branchial cleft (BC) sinus/fistula anomalies usually present in children. Their definitive management requires complete tract surgical excision, which necessities accurate extension assessment. Our aim is to propose and describe a novel intraoperative endoscopic technique that can help in evaluating the exact BC anomaly tract extension and overcome disadvantages of currently used methods including imaging and intraoperative methylene blue tract injection.
Methods
The innovative intraoperative endoscopic technique involves performing BC sinus/fistula tract intraluminal endoscopy utilizing miniature 1.3 or 1.6 mm all-in-one semi-rigid endoscopes as well as other accessory equipment currently available and used for sialendoscopy for delineation of exact tract extension followed by a complete standard surgical excision tailored to and assisted by the endoscopic procedure.
Results
This novel endoscopic technique was used successfully in five children (age range 8–16 years) presenting with unilateral or bilateral congenital second BC discharging fistula/sinus tracts in the neck. Intraoperative endoscopic assessment took 10–15 min and confirmed the exact tract extension and nature in all patients without complications. Five fistulas and two sinuses were identified and completely surgically resected. No recurrence has been observed after a median follow-up of 29 (range 13–45) months.
Conclusion
Intraoperative second BC fistula/sinus tract endoscopy could help in accurately assessing anomaly extension, thereby assisting in complete surgical excision. This innovative novel endoscopic technique could avoid disadvantages of currently used methods, especially regarding radiation exposure required for imaging children in whom this anomaly usually presents.
References
Maddalozzo J, Rastatter JC, Dreyfuss HF, Jaffar R, Bhushan B (2012) The second branchial cleft fistula. Int J Pediatr Otorhinolaryngol 76:1042–1045. https://doi.org/10.1016/j.ijporl.2012.04.002
Cheng J, Elden L (2012) Management of pediatric second branchial fistulae: is tonsillectomy necessary? Int J Pediatr Otorhinolaryngol 76(11):1601–1603. https://doi.org/10.1016/j.ijporl.2012.07.024
Ford GR, Balakrishnan A, Evans JN, Bailey CM (1992) Branchial cleft and pouch anomalies. J Laryngol Otol 106:137–143. https://doi.org/10.1017/s0022215100118900
Li W, Xu H, Zhao L, Li X (2018) Branchial anomalies in children: a report of 105 surgical cases. Int J Pediatr Otorhinolaryngol 104:14–18. https://doi.org/10.1016/j.ijporl.2017.10.035
Waldhausen JH (2006) Branchial cleft and arch anomalies in children. Semin Pediatr Surg 15:64–69. https://doi.org/10.1053/j.sempedsurg.2006.02.002
Ang AH, Pang KP, Tan LK (2001) Complete branchial fistula. Case report and review of the literature. Ann Otol Rhinol Laryngol 110:1077–1079. https://doi.org/10.1177/000348940111001116
Piccioni M, Bottazzoli M, Nassif N, Stefini S, Nicolai P (2016) Intraoperative use of fibrin glue dyed with methylene blue in surgery for branchial cleft anomalies. Laryngoscope 126:2147–2150. https://doi.org/10.1002/lary.25833
Kajosaari L, Makitie A, Salminen P, Klockars T (2014) Second branchial cleft fistulae: patient characteristics and surgical outcome. Int J Pediatr Otorhinolaryngol 78:1503–1507. https://doi.org/10.1016/j.ijporl.2014.06.020
Gutierrez C, Bardají C, Bento L, Martinez MA, Conde J (1993) Branchio-oto-renal syndrome: Incidence in three generations of a family. J Pediatr Surg 28:1527–1529. https://doi.org/10.1016/0022-3468(93)90086-Z
Van Zele T, Katrien B, Philippe D, Hubert V (2010) Stripping of a fistula for complete second branchial cleft. J Plast Reconstr Aesthet Surg 63(6):1052–1054. https://doi.org/10.1016/j.bjps.2009.11.013
Kim BH, Kwon SK, Hah JH (2018) Chemocauterization of second branchial cleft fistula using trichloroacetic acid: a preliminary report. Auris Nasus Larynx 45(1):143–146. https://doi.org/10.1016/j.anl.2017.03.015
Bajaj Y, Ifeacho S, Tweedie D, Jephson CG, Albert DM, Cochrane LA, Wyatt ME, Jonas N, Hartley BE (2011) Branchial anomalies in children. Int J Pediatr Otorhinolaryngol 75(8):1020–1023. https://doi.org/10.1016/j.ijporl.2011.05.008
Rattan KN, Rattan S, Parihar D, Gulia JS, Yadav SP (2006) Second branchial cleft fistula: is fistulogram necessary for complete excision. Int J Pediatr Otorhinolaryngol 70(6):1027–1030. https://doi.org/10.1016/j.ijporl.2005.10.014
Schroeder JW Jr, Mohyuddin N, Maddalozzo J (2007) Branchial anomalies in the pediatric population. Otolaryngol Head Neck Surg 137(2):289–295. https://doi.org/10.1016/j.otohns.2007.03.009
Choi SS, Zalzal GH (1995) Branchial anomalies: a review of 52 cases. Laryngoscope 105(9 Pt 1):909–913. https://doi.org/10.1288/00005537-199509000-00007
Shen LF, Zhou SH, Chen QQ, Yu Q (2018) Second branchial cleft anomalies in children: a literature review. Pediatr Surg Int 34(12):1251–1256. https://doi.org/10.1007/s00383-018-4348-8
Guarisco JL, Fatakia A (2008) Intraoperative fistulograms in the management of branchial apparatus abnormalities in children. Int J Pediatr Otorhinolaryngol 72(12):1777–1782. https://doi.org/10.1016/j.ijporl.2008.08.017
Yilmaz I, Cakmak O, Ozgirgin N, Boyvat F, Demirhan B (2004) Complete fistula of the second branchial cleft: case report of catheter-aided total excision. Int J Pediatr Otorhinolaryngol 68(8):1109–1113. https://doi.org/10.1016/j.ijporl.2004.04.016
Srinath N, Kashi VN (2011) The use of catheter simplifies the excision of complete branchial fistula—a novel technique. Asian J Oral Maxillofac Surg 23(2):77–79. https://doi.org/10.1016/j.ajoms.2010.12.004
Gillespie MB, O'Connell BP, Rawl JW, McLaughlin CW, Carroll WW, Nguyen SA (2015) Clinical and quality-of-life outcomes following gland-preserving surgery for chronic sialadenitis. Laryngoscope 125(6):1340–1344. https://doi.org/10.1002/lary.25062
Barrett G, Toynton S (2013) Endoscopically assisted branchial fistula excision. Int J Pediatr Otorhinolaryngol 77(6):1048–1050. https://doi.org/10.1016/j.ijporl.2013.01.008
Süslü N, Süslü AE, Akyol U, Yılmaz T (2013) Minimally invasive endoscope-assisted surgery for bilateral branchial cleft fistula. Laryngoscope 123(9):2296–2299. https://doi.org/10.1002/lary.23826
Acknowledgements
The authors would like to thank Dr. Mohamed Khaled Taha (Resident, Department of Otorhinolaryngology-Head & Neck Surgery, Faculty of Medicine, Alexandria University) for his assistance in editing the supplementary, online included, surgical technique video.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee, and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from parents or legal guardians of children patients included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Online resource 1 Video demonstrating details of second BC sinus/fistula intraluminal endoscopy for intraoperative assessment of tract extension (MP4 94229 kb)
Rights and permissions
About this article
Cite this article
Magdy, E.A., Hamza, A., Youssef, A. et al. Second branchial cleft fistula/sinus tract endoscopy: a novel intraoperative technique assisting complete surgical resection. Eur Arch Otorhinolaryngol 278, 833–838 (2021). https://doi.org/10.1007/s00405-020-06158-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-020-06158-6