Endoscopic Management of Branchial Fistula: Diagnostic and Therapeutic.

Recurrent neck abscess is a typical feature of branchial anomaly. Open surgical excision has been the primary treatment modality for past decades however several alternative treatment modalities such as endoscopic electrocauterization has recently gained popularity and acceptance universally. This series aims to introduce endoscopic assessment as the first line diagnostic and therapeutic management for branchial fistula. 5 patients underwent examination under general anesthesia via direct laryngoscopy, endoscopic assessment and cauterization in our centre from 2016 to 2019. They were then followed up at our clinic to assess disease progression. Comparison between open neck surgery and endoscopic cauterization of internal sinus tract opening as the primary treatment has reported similar recurrence rate. Proposal of endoscopic assessment as the first line investigation and diagnostic tool with the aim of therapeutic cauterization at the same setting. MRI may be needed in scenarios such as failed endoscopic treatment or when open surgery is required.

Complete First Branchial Fistula in a Child Extending from the External Auditory Canal to the Oropharynx

We report the clinical presentation and CT and MR imaging findings in a child with an unusual first branchial apparatus fistula that extends from the external auditory canal to the oropharynx.

Four Cases of Esophageal Diverticulum Presented as Incidentally Discovered Asymptomatic Posterior Thyroid Nodules

Esophageal content in the thyroid by fine-needle aspiration is a rare occurrence. Here are four cases of esophageal diverticulum that presented as incidentally discovered asymptomatic posterior thyroid nodules in four patients (one 85-year-old female, one 85-year-old male, one 57-year-old male, and one 26-year-old female) who underwent ultrasound-guided fine-needle aspiration (FNA). The FNA cytopathological findings include bland mature nonkeratinizing superficial squamous cells, abundant filamentous bacteria, scattered degenerated chronic inflammatory cells, and amorphous debris, consistent with oral pharyngeal contents. These findings in the thyroid FNA biopsy may raise differential diagnoses, including Zenker diverticulum and Killian-Jamieson diverticulum of the esophagus, thyroglossal duct fistula and a third or fourth branchial fistula, and benign epidermal inclusion cyst. Thyroglossal duct fistula appears as a midline tract, which may connect the thyroid gland and the foramen cecum, as well as the branchial fistula usually present in the pediatric population, and it may connect the thyroid gland and the hypopharyngeal piriform sinus, although with an unusual presentation seen in adults. However, all four cases were reviewed with radiologists and confirmed as deep posterior thyroid nodules. The squamous epidermal inclusion cyst is usually in the superficial dermis and has predominantly anucleated squamous cells and very few if any well-preserved nucleated squamous cells. The abundant filamentous bacteria/yeast may represent colonization and no infection, which is confirmed by almost absence of neutrophils. So, the final diagnosis of these four cases is suggestive of esophageal diverticulum and no surgical treatment is necessary with the recommendation of esophagogastroduodenoscopy. As noted above, there is no evidence of malignancy; however, the false-negative rate of FNA diagnosis in a squamous-related entity is reported to be about 2% to 5%, so these patients are deemed appropriate for follow-up. In summary, we presented four cases of incidentally discovered asymptomatic posterior thyroid nodules suggestive of esophageal diverticulum by FNA biopsy.

Three cases of branchial fistula in one family: a rare presentation

<p>Branchial cleft anomalies comprise approximately 30% of congenital neck mass and present as cyst, sinus or fistula. They occur due to disturbance in the maturation of the branchial apparatus during fetal development. They are congenital lesions usually present in childhood, but they are usually diagnosed in later childhood or early adulthood because of enlargement or infection. Branchial cleft fistulae are usually diagnosed earlier than cysts. Correct diagnosis leads to proper management. Complete surgical excision is the treatment of choice. Second branchial cleft and pouch anomalies are commonest amongst all branchial cleft lesions, but complete second branchial cleft anomalies with external and internal opening is rare. Branchial anomalies with family history are also very rare. Here we present a case report of complete branchial fistula with family history which was managed by complete excision of fistula through transcervical and transoral approaches. 3 members of one family in 2 generations presented with branchial apparatus anomalies (father and his two children, elder son and younger daughter). All of them were having branchial fistula on right side of neck since birth.</p>

Second branchial cleft fistula in a child with genetically confirmed branchio-oto-renal (BOR) syndrome

Branchial cleft anomalies constitute 32% to 45% of all neck pathologies in the pediatric population. These disorders may be a part of a branchio-oto-renal syndrome (Melnick-Fraser syndrome), characterized by branchial arch abnormalities, preauricular pits, hearing impairment, and various types of renal anomalies. Usually, the treatment of a branchial fistula does not necessarily require extensive diagnostics. However, in patients with a congenital branchial cleft fistula associated with ear anomalies recognized during a physical examination, and history of hearing loss or similar findings in other relatives, the additional analysis should be carried out to eliminate the possibility of BOR syndrome. The aim of this study is to present a rare case of a male patient presenting complete second branchial cleft fistula, diagnosed as having BOR syndrome.