title: The relationship between the fistula tract and the facial nerve in type II first branchial cleft anomalies.
abstract: OBJECTIVE
  To share our experience involving seven patients with type II first branchial cleft anomalies (hereafter, type II anomalies), to determine whether the location of the external fistula openings of the anomalies are associated with the location of the facial nerve tract, and elucidate the relationship between the location of the fistula opening and the facial nerve.
  
  
  METHODS
  The medical records of seven patients who underwent surgery from 2005 to 2013 for type II anomalies were retrospectively examined. The relationship between the fistula opening and the facial nerve was evaluated in each patient with respect to whether the fistula opening was superior or inferior to the mandibular angle. All patients underwent partial parotidectomy, facial nerve exposure, and total excision of the mass together with connection of a small cuff of the external auditory canal skin to the fistula tract.
  
  
  RESULTS
  The fistula tracts were located medially to the facial nerve in two patients, and both fistulae had openings inferior to the mandibular angle. The fistula tracts were located laterally to the facial nerve in the remaining five patients: one patient had no external opening, one had an opening inferior to the mandibular angle, and the remaining three had openings superior to the mandibular angle.
  
  
  CONCLUSIONS
  Because type II anomalies are rare, their diagnosis is difficult. Surgery of such lesions is challenging and associated with a high risk due to their proximity to the facial nerve. We believe that the location of the fistula opening may help to identify the relationship between the anomalous lesion and facial nerve. Studies involving larger series of cases are needed to confirm our hypothesis; however, because of the rarity of this specific anomaly, it will not be easy to compile a large number of cases. We believe that our study will encourage further investigation on this subject.
authors.affiliation: Department of Otorhinolaryngology, Acibadem University, Medical School, Maslak, Istanbul, Turkey. Electronic address: burak.ertas@acibadem.com.tr.
authors.forename: Burak
authors.initials: B
authors.lastname: Ertas
authors.affiliation: Department of Otorhinolaryngology, Hacettepe University, Medical School, Sihhiye, Ankara, Turkey.
authors.forename: Rıza Onder
authors.initials: RO
authors.lastname: Gunaydin
authors.affiliation: Department of Otorhinolaryngology, Acibadem University, Medical School, Maslak, Istanbul, Turkey.
authors.forename: Omer Faruk
authors.initials: OF
authors.lastname: Unal
mesh_terms: D001934:Branchial Region / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery; D002675:Child, Preschool; D015331:Cohort Studies; D019465:Craniofacial Abnormalities / Q000473:pathology* / Q000601:surgery; D017577:Cutaneous Fistula / Q000473:pathology* / Q000601:surgery; D004424:Ear Canal / Q000601:surgery; D005154:Facial Nerve / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010608:Pharyngeal Diseases / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies
keywords: Branchial anomaly; Facial nerve; Tract of branchial fistula