title: The second branchial cleft fistula.
abstract: OBJECTIVE
  To review the surgical anatomy and histopathology of second branchial cleft fistulae.
  
  
  METHODS
  Retrospective study of patients treated for second branchial cleft fistulae at a tertiary care pediatric hospital. The senior author noted anatomic and histologic features of second branchial cleft fistulae, not previously described.
  
  
  METHODS
  Tertiary care children's hospital.
  
  
  METHODS
  Retrospective examination of 28 patients was conducted who were operated upon for second branchial cleft fistula. Data collected included age at surgery, initial presentation, imaging characteristics prior to surgery, laterality of the fistula tract, pathology results and follow-up data.
  
  
  RESULTS
  Twenty-eight patients met the criteria for inclusion. Three patients (11%) had bilateral fistulae. 11 (39%) were male and 17 (61%) were female. 23 (74.2%) tracts were lined with ciliated columnar epithelium, 3 (9.7%) had cuboidal epithelium, and 5 (16.7%) had squamous epithelium. Nineteen (61.3%) tracts contained salivary tissue. Of the unilateral fistula tracts, 25 (100%) were on the right side. Of the 3 patients with bilateral lesions, 2 (66%) had associated branchio-oto-renal syndrome (BORS).
  
  
  CONCLUSIONS
  Second branchial cleft fistulae are rare. They are usually right-sided. If bilateral fistulae are present, one should consider an underlying genetic disorder. The histology of the fistulae mostly demonstrates ciliated columnar epithelium with the majority of specimens showing salivary tissue. There is a clear association with the internal jugular vein (IJV). Dissection should continue until superior to the hyoid bone, ensuring near complete surgical dissection and less risk of recurrence.
authors.affiliation: Division of Pediatric Otolaryngology, Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614, USA. jpmaddalozzo@childrensmemorial.org
authors.forename: John
authors.initials: J
authors.lastname: Maddalozzo
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Rastatter
authors.forename: Heath F
authors.initials: HF
authors.lastname: Dreyfuss
authors.forename: Reema
authors.initials: R
authors.lastname: Jaffar
authors.forename: Bharat
authors.initials: B
authors.lastname: Bhushan
mesh_terms: D001934:Branchial Region / Q000033:anatomy & histology / Q000473:pathology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies