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
According to the reports, endoscopic cauterization and open cervical fistulectomy are used to treat third branchial cleft fistulas. Both of them are associated with high recurrence rates. Incomplete resection of all anatomic elements of the fistula may be the main cause of recurrence.
A combined therapy was designed to completely resect the fistula.
Here, 12 adult patients who were diagnosed with recurrent third branchial cleft fistulas were included. The patients were treated by endoscopic cauterization or open cervical fistulectomy before, and the fistulas were observed for recurrence at least once.
The fistula was traced near the thyroid cartilage, and partial thyroid cartilage was resected to expose the pyriform fossa more clearly. The scar close to the pyriform fossa was eased, and the guidewire was inserted into the pyriform sinus to the fistula by flexible fiber-optic pharyngoscopy, which was then located in the neck incision. All anatomical elements of the fistula could be resected.
Twelve recurrent third branchial cleft fistulas were completely ablated by the combined method, and no recurrence was found during the 13-60 mo follow-up period.
In this study, the combined method could expose the hole fistula more clearly and ablate all of the elements of the fistula more easily. Partial resection of the thyroid cartilage could expose the pyriform sinus clearly, and the inner opening could be found from the neck incision. Flexible fiber-optic pharyngoscope could help to locate the inner opening of the pharynx.
The combined method may be a good way to ablate the third branchial cleft fistulas completely, especially for recurrent fistulas. Also, further studies with more cases, control groups, and long-term follow-ups are needed to make precise conclusions.