A rare case of complete second arch branchial fistula in a 7-year-old child
A 7-year-old boy presented with complaints of watery discharge from an opening in the left side of neck, on and off since 4 years of age. The discharge occurred only during eating or drinking. There was a history of few episodes of swelling at the site of the opening, associated with fever. On examination, there was pinhead-sized opening seen at the junction of middle and lower third of left sternocleidomastoid at its anterior border []. Watery discharge could be seen coming from the opening on making the child to drink water []. A clinical diagnosis of branchial fistula was made.\nPreoperative pharyngoscopy was normal. A contrast study was done by injecting gastrografin into the external opening, which showed the internal opening at the lateral aspect of pharyngeal wall in the supratonsillar fossa. The patient was able to feel the taste of contrast material in and the esophagus too showed the swallowed contrast, confirming the diagnosis of “complete” branchial fistula [].\nThe child was planned for surgery under general anesthesia. An elliptical incision was made encircling the opening. Subplatysmal flaps were raised. A prolene suture (size 1) was used to probe the fistulous tract. The fistulous tract was traced along carotid sheath where it turned medially to pass between the internal and external carotid arteries. The tract was deep to posterior belly of digastric opening into the supratonsillar fossa. The fistula was excised completely. Wound was closed without drain. Postoperative recovery was uneventful.