Complete second branchial cleft fistula in a fifteen-year-old boy: A case report.

Abstract

Introduction and importance: The branchial or pharyngeal apparatus, crucial in embryological development, consists of clefts, arches, pouches, and membranes. Anomalies arising from this apparatus particularly involving the second branchial arch, are rare. Among these anomalies, complete second branchial cleft fistulas, with both external and internal openings, are exceptionally uncommon. This case report presents such a rarity in a fifteen-year-old boy, highlighting the clinical presentation, diagnostic approach, surgical management, and outcome.

Case presentation: A fifteen-year-old boy presented with a history of mucoid discharge from an opening on the lateral aspect of the right neck, noticed since birth. Clinical examination revealed a pinhole opening along the anterior border of the sternocleidomastoid muscle. Imaging studies confirmed the diagnosis of a complete second branchial cleft fistula, extending from the right lateral neck to the right tonsillar fossa. Surgical excision using a stepladder approach was performed under general anesthesia, leading to complete resolution of symptoms.

Clinical discussion: Complete second branchial cleft fistula is a rare entity. The diagnosis requires thorough history and examination, imaging, biopsy and surgical excision along with certain period of folllow-up.

Conclusion: Complete second branchial cleft fistulas are exceedingly rare congenital anomalies, typically presenting with mucoid discharge from a neck opening since birth. Diagnosis involves clinical examination and imaging studies, such as sinography with water-soluble contrast. Surgical excision, often via a stepladder approach, remains the mainstay of treatment, resulting in favorable outcomes. Early recognition and prompt intervention are essential for optimal management.