title: Second branchial cleft fistulae: patient characteristics and surgical outcome.
abstract: BACKGROUND
  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.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, P.O. Box 220, FI-00029 HUCH, Helsinki, Finland. Electronic address: lauri.kajosaari@hus.fi.
authors.forename: Lauri
authors.initials: L
authors.lastname: Kajosaari
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, P.O. Box 220, FI-00029 HUCH, Helsinki, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Mäkitie
authors.affiliation: Department of Pediatric Surgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Päivi
authors.initials: P
authors.lastname: Salminen
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, P.O. Box 220, FI-00029 HUCH, Helsinki, Finland.
authors.forename: Tuomas
authors.initials: T
authors.lastname: Klockars
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001934:Branchial Region / Q000002:abnormalities* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Branchial anomalies; Surgery