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
Abstract
BACKGROUND

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.

AIM

To present a new approach that involves complete resection of the recurrent fistula by a combined therapeutic approach.

METHODS

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.

RESULTS

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.

CONCLUSION

It can be concluded that the proposed combined therapy is associated with excellent results, minimal morbidity, and no recurrence.

Keywords: Branchial cleft fistula, Resection, Fiber-optic pharyngoscopy, Pyriform sinus fistula, Guidewire

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.