title: A true branchial fistula in the context of branchiootic syndrome: challenges of diagnosis and management.
abstract: BACKGROUND
  The presence of a branchial fistula with communication both internally and externally: a 'true' branchial fistula is rare, and may arise in the context of autosomal dominant conditions such as branchiootic syndrome and branchiootorenal syndrome.
  
  
  METHODS
  We discuss the case of a true branchial fistula, which recurred after initial surgical excision, in a patient with branchiootic syndrome. The residual tract was dissected in a second operation through stepladder neck incisions and removed in toto via an intraoral approach. No renal abnormalities were detected on investigation with ultrasound.
  
  
  CONCLUSIONS
  Incomplete excision of a branchial sinus is likely to cause recurrence however intraoperative visualisation of the tract can can sometimes prove challenging. An combined intraoral and external approach aids delineation and tract definition when there is a true branchial fistula and can therefore facilitate a complete excision. Suspicion of an hereditary aetiology should be raised in patients with bilateral or preauricular features, or a positive family history, which may then prompt additional renal and genetic investigation.
authors.affiliation: University of Cambridge, Cambridge, UK.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Jovic
authors.affiliation: University of Cambridge, Cambridge, UK.
authors.forename: Francesca
authors.initials: F
authors.lastname: Saldanha
authors.affiliation: University of Cambridge, Cambridge, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Kuo
authors.affiliation: Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, CB2 0QQ, UK. Electronic address: tariq.ahmad@addenbrookes.nhs.uk.
authors.forename: Tariq
authors.initials: T
authors.lastname: Ahmad
mesh_terms: D019280:Branchio-Oto-Renal Syndrome / Q000150:complications / Q000175:diagnosis; D001935:Branchioma / Q000151:congenital / Q000175:diagnosis / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006258:Head and Neck Neoplasms / Q000151:congenital / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007223:Infant; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D014068:Tonsillectomy
keywords: Branchiootic syndrome; Intraoral approach; Recurrent branchial fistula; True branchial fistula