Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2019; 7(23): 3957-3963
Published online Dec 6, 2019. doi: 10.12998/wjcc.v7.i23.3957
Resection of recurrent third branchial cleft fistulas assisted by flexible pharyngotomy
Xiao-Qiong Ding, Xin Zhu, Ling Li, Xu Feng, Zhi-Chun Huang
Xiao-Qiong Ding, Xin Zhu, Ling Li, Xu Feng, Zhi-Chun Huang, Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital Southeast University, Nanjing 210000, Jiangsu Province, China
Author contributions: Huang ZC and Ding XQ contributed to study conception and design; Zhu X and Li L contributed to data acquisition, data analysis and interpretation, and writing of the article; Ding XQ, Zhu X, Li L, Feng X and Huang ZC contributed to editing, reviewing and final approval of the article.
Institutional review board statement: The study protocol was approved by the Ethics Committee of the Zhongda Hospital, Southeast University (Nanjing, China), and conducted in accordance with the 1975 Declaration of Helsinki.
Informed consent statement: All the patients signed the written informed consent form.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: All the data in the paper, the authors agree to share the data.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zhi-Chun Huang, MSc, Doctor, Professor, Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital Southeast University, No. 87 Dingjiaqiao, Nanjing 210000, Jiangsu Province, China. huang1963618@sohu.com
Telephone: +86-13505154973
Received: September 3, 2019
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
Research background

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.

Research motivation

A combined therapy was designed to completely resect the fistula.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.