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Second branchial cleft fistulae: patient characteristics and surgical outcome
Lauri Kajosaari1, Antti Mäkitie1, Päivi Salminen2
1Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, P.O. Box 220, FI-00029 HUCH, Helsinki, Finland.
Insights
Surgical outcomes for second branchial cleft anomalies are reliable, with no significant impact from patient factors or tonsillectomy. Delaying surgery until age three minimizes risks, and routine tonsillectomy is not recommended.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Congenital Anomalies
Background:
- Second branchial cleft anomalies often lead to recurrent infections, necessitating surgical intervention.
- Optimal timing and surgical techniques for these anomalies lack established consensus.
- This study evaluates patient characteristics and treatment outcomes to inform surgical decisions.
Purpose of the Study:
- To compare the impact of patient age and surgical techniques on treatment outcomes for second branchial cleft anomalies.
- To analyze patient characteristics, preoperative investigations, and postoperative sequelae.
- To provide evidence-based recommendations for the management of these congenital anomalies.
Main Methods:
- Retrospective analysis of 68 pediatric patients treated for second branchial sinuses or fistulae (1998-2012).
- Comparison of patient demographics, preoperative workup, surgical approaches, and postoperative complications.
- Evaluation of outcomes based on age at surgery and specific surgical techniques, including tonsillectomy.
Main Results:
- The study represents the largest series of second branchial cleft anomalies reported.
- Preoperative infectious symptoms were present in 24% of patients and did not significantly affect surgical outcomes.
- Neither patient demographics, preoperative investigations, methylene blue use, nor tonsillectomy influenced surgical success. No re-operations were required; three minor postoperative complications occurred.
Conclusions:
- This large series confirms that preoperative symptoms are infrequent and mild, with no significant impact on outcomes.
- Surgical outcomes were consistent across different departments and did not benefit from ipsilateral tonsillectomy.
- Delaying surgery until approximately age three is advisable to minimize anesthesiological risks and potential harms, avoiding routine tonsillectomy due to risks of pain and hemorrhage.
Backgrounds:
Second branchial cleft anomalies predispose to recurrent infections, and surgical resection is recommended as the treatment of choice. There is no clear consensus regarding the timing or surgical technique in the operative treatment of these anomalies. Our aim was to compare the effect of age and operative techniques to patient characteristics and treatment outcome.
Methods:
A retrospective study of pediatric patients treated for second branchial sinuses or fistulae during 1998-2012 at two departments in our academic tertiary care referral center. Comparison of patient characteristics, preoperative investigations, surgical techniques and postoperative sequelae.
Results:
Our data is based on 68 patients, the largest series in the literature. One-fourth (24%) of patients had any infectious symptoms prior to operative treatment. Patient demographics, preoperative investigations, use of methylene blue, or tonsillectomy had no effect on the surgical outcome. There were no re-operations due to residual disease. Three complications were observed postoperatively.
Conclusions:
Our patient series of second branchial cleft sinuses/fistulae is the largest so far and enables analyses of patient characteristics and surgical outcomes more reliably than previously. Preoperative symptoms are infrequent and mild. There was no difference in clinical outcome between the observed departments. Performing ipsilateral tonsillectomy gave no outcome benefits. The operation may be delayed to an age of approximately three years when anesthesiological risks are and possible harms are best avoided. Considering postoperative pain and risk of postoperative hemorrhage a routine tonsillectomy should not be included to the operative treatment of second branchial cleft fistulae.
