title: Chemocauterization of second branchial cleft fistula using trichloroacetic acid: A preliminary report.
abstract: OBJECTIVE
  Although second branchial cleft fistula (BCF) can be well treated with surgical excision, neck scarring is unavoidable. We previously reported chemocauterization with trichloroacetic acid (TCA) to close various fistulas. Here, we report chemocauterization of a second BCF without a consequent incision scar.
  
  
  METHODS
  This procedure was applied in four pediatric patients whose parents were reluctant to undergo surgical excision for a second BCF. Under general anesthesia, a thin metal suction tip or cut down tube was inserted through the skin opening. Normal saline with or without dye was injected to identify the pharyngeal opening around the palatine tonsil, and 75% TCA solution mixed with dye was injected. Leaked TCA at the pharynx was sucked out meticulously to avoid extensive and unexpected injury to the mucosa, and the external opening was sealed with a thin adhesive film.
  
  
  RESULTS
  There were no immediate complications and recurrence of a second BCF in all patients during the median follow-up of 23 months (range, 18-88 months) with minimal neck scarring.
  
  
  CONCLUSIONS
  TCA chemocauterization of second BCF could be a simple, less invasive, and feasible treatment option in pediatric patients.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Bo Hae
authors.initials: BH
authors.lastname: Kim
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Seong Keun
authors.initials: SK
authors.lastname: Kwon
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, South Korea. Electronic address: jhunhah@snu.ac.kr.
authors.forename: J Hun
authors.initials: JH
authors.lastname: Hah
mesh_terms: D001934:Branchial Region / Q000002:abnormalities* / Q000000981:diagnostic imaging; D002424:Caustics / Q000627:therapeutic use*; D002425:Cautery / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D014238:Trichloroacetic Acid / Q000627:therapeutic use*
chemical_list: D002424:Caustics; D014238:Trichloroacetic Acid
keywords: Branchial cleft anomalies; Fistula; Minimally invasive surgical procedures; Trichloroacetic acid