Published online Dec 6, 2019. doi: 10.12998/wjcc.v7.i23.3957
Peer-review started: September 3, 2019
First decision: September 23, 2019
Revised: October 29, 2019
Accepted: November 15, 2019
Article in press: November 15, 2019
Published online: December 6, 2019
Treatment of fistulas arising from the third branchial cleft includes endoscopic cauterization or open cervical fistulectomy. Both approaches are associated with recurrence rates of 14%-18%, and possibly greater rates when the fistula has been treated operatively beforehand. Treatment of fistulas arising from the third branchial cleft is associated with an inordinate recurrence rate. Recurrence may be multifactorial and related to incomplete resection of all of the anatomical elements of the fistula.
To present a new approach that involves complete resection of the recurrent fistula by a combined therapeutic approach.
Here, 12 adult patients diagnosed with recurrent third branchial cleft fistulas underwent a combined therapy assisted by flexible fiber-optic pharyngoscopy to identify and resect the entry site of the fistula into the pyriform sinus. The fistulous opening into the pyriform sinus was identified by flexible fiber-optic pharyngoscopy. The application of intubation with a guidewire by pharyngoscopy, in addition to the removal of the partial excision of the thyroid cartilage, allowed complete resection of the opening and all parts of the fistula tract.
All of the internal openings of the fistulas in the pharynx were found and easily identified by flexible fiber-optic pharyngoscopy. All of the 12 patients underwent complete resection of the recurrent fistula by the combined therapeutic approach. There were no postoperative complications such as parapharyngeal abscess or wound infection, injury or dysfunction of the recurrent laryngeal or superior laryngeal nerves. The pharyngeal edema had degraded, and the pharyngeal wound healed postoperatively within 1 wk. Laryngeal endoscopy and voice analysis were performed on the 14th d post-operatively. Vocal cord movements did not change. The characters of voice for jitter, shimmer, and normalized noise energy were all within normal limits. In addition, no recurrences were observed during the 13-60 mo follow-up period.
It can be concluded that the proposed combined therapy is associated with excellent results, minimal morbidity, and no recurrence.
Core tip: In this work, we present our experience with complete resection of the recurrent branchial cleft fistula by a revised combined approach. This approach involves an open cervical fistulectomy with partial resection of the thyroid cartilage and excision of the fistulous opening into the pyriform sinus as aided by fiberoptic pharyngoscopy. This approach allows total resection of the fistula, as well as its opening into the pharynx. Our experience with this combined approach is associated with excellent results, minimal morbidity, and no recurrences.