An extremely rare case of adult with first branchial cleft fistula: Case report

Abstract

Introduction: Anomalies of the first branchial cleft are rare and represent 10% of lateral cervical malformations. Very few cases have been described in literature. In our research, we didn't find cases of adults with first branchial cleft fistulas. First branchial cleft fistulas in adults are difficult to diagnosticate, and the surgery of the parotid gland to extract the fistula requires to be precautious.

Case presentation: The aim of this work is to present an extremely rare case of a 65 years-old patient with first branchial cleft fistula. Fistula excision surgery completed with superficial parotidectomy were performed. No sign of recurrency were found after 6 months surveillance.

Discussion: First branchial cleft fistula is hard to diagnosticate, especially with adults. Very few cases of adult male are described in the literature. It is often misdiagnosed with parotid tumours or as otitis with ear drainage.The treatment of First branchial cleft fistula is surgical. A complete resection of the tract is necessary to prevent recurrency. It usually requires a superficial parotidectomy and the fistula tract passes under the parotid gland.

Conclusion: First branchial cleft fistulas are rare, and forms with adults are extremely rare to encounter. Imagery can't always help to diagnosis. Surgery is indicated in the management of this pathology, with preservation of the facial nerve.

Keywords: Branchial cleft anomalies; Branchial cleft fistula; Facial nerve.

Fig. 1

Patient with left cleft fistula behind the ear lobe.

Fig. 2

Orifice of fistula in external auditory canal.

Fig. 3

Per operative view with dissection of facial nerve.