Summary about Disease
A branchial cleft fistula is an abnormal channel that forms during embryonic development, connecting the skin surface of the neck to the pharynx (throat). It arises from incomplete closure of the branchial arches, which are structures present during fetal development that eventually form the neck and head. These fistulas can be asymptomatic but often present with drainage, swelling, or infection in the neck.
Symptoms
A small opening (pit or dimple) on the side of the neck, usually along the lower third of the sternocleidomastoid muscle.
Intermittent drainage of clear mucus from the opening.
Swelling or tenderness around the opening, especially during an upper respiratory infection.
Redness and warmth in the area, indicating infection.
Skin tags near the opening.
Recurrent infections or abscesses in the neck.
In rare cases, difficulty swallowing or breathing, especially if the fistula is large or infected.
Causes
Branchial cleft fistulas are congenital, meaning they are present at birth. They occur due to incomplete obliteration of the branchial clefts during embryonic development. Specifically, they typically arise from the second branchial arch. The exact reason why this failure occurs is not fully understood, but it is believed to be related to genetic and environmental factors during pregnancy.
Medicine Used
Antibiotics: If the fistula becomes infected, antibiotics are prescribed to treat the infection. The specific antibiotic used will depend on the type of bacteria causing the infection.
Pain relievers: Over-the-counter pain relievers like ibuprofen or acetaminophen can be used to manage pain and discomfort.
Antihistamines or decongestants: If the fistula is associated with upper respiratory infection symptoms, antihistamines or decongestants may be used to manage nasal congestion or allergic reactions.
Surgical intervention: Surgical excision is the definitive treatment.
Is Communicable
No, a branchial cleft fistula is not communicable. It is a congenital defect and not caused by an infectious agent. It cannot be spread from person to person.
Precautions
Keep the area around the fistula opening clean and dry.
Avoid squeezing or picking at the opening.
Seek medical attention if signs of infection develop (redness, swelling, pain, drainage).
Follow the doctor's instructions regarding wound care after surgical excision.
Report any recurrence of symptoms to the doctor.
How long does an outbreak last?
There are no outbreaks. A branchial cleft fistula is a structural defect that is always present. However, inflammation or infection can occur intermittently, lasting days to weeks depending on the severity and treatment. Surgical correction resolves the fistula permanently.
How is it diagnosed?
Physical examination: The diagnosis is usually made based on a physical examination of the neck, identifying the characteristic pit or opening.
Fistulogram: A fistulogram involves injecting a contrast dye into the opening and taking X-rays to visualize the tract and its connection to the pharynx.
CT scan or MRI: These imaging studies can provide more detailed information about the fistula's anatomy and its relationship to surrounding structures, especially if surgery is being considered.
Endoscopy: In some cases, endoscopy (using a small camera inserted through the mouth or nose) may be used to visualize the internal opening of the fistula in the pharynx.
Timeline of Symptoms
Birth: The fistula is present at birth, though it may not be immediately noticeable.
Infancy/Childhood: The opening may be noted incidentally during routine care. Drainage may occur intermittently, especially during or after upper respiratory infections.
Any age: Infection can occur at any age, leading to swelling, redness, pain, and drainage.
Important Considerations
Branchial cleft fistulas can be associated with other congenital anomalies, so a thorough evaluation is important.
Surgical excision is the definitive treatment, but recurrence can occur if the entire tract is not removed.
The surgeon should have experience with pediatric neck surgery to minimize the risk of complications.
Patients should be monitored for signs of recurrence after surgery.
Early diagnosis and treatment can prevent recurrent infections and improve cosmetic outcomes.