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81st Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

12.05. - 16.05.2010, Wiesbaden

A fistula between outer ear canal and oropharynx – a seldom first branchial cleft anomaly

Meeting Abstract

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  • corresponding author presenting/speaker Wolfram Pethe - HNO-Klinik, AMEOS-Klinikum, Halberstadt, Germany
  • Jörg Langer - HNO-Klinik, AMEOS-Klinikum, Halberstadt, Germany
  • Klaus Begall - HNO-Klinik, AMEOS-Klinikum, Halberstadt, Germany

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. 81st Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. Wiesbaden, 12.-16.05.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. Doc10hno013

DOI: 10.3205/10hno013, URN: urn:nbn:de:0183-10hno0135

Published: July 6, 2010

© 2010 Pethe et al.
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Outline

Text

The extended first branchial cleft fistula is with a yearly incidence of less then 1 to 1000000 a rather rare diagnosis. Therefore they are frequently misdiagnosed and -treated. During the 4th week of human ontogenesis the embryo forms four branchial arcs which are delimited by ectodermal branchial clefts. Only the first branchial cleft remains as a structure and forms the outer ear canal.

Disorders during the development of the first branchial cleft leads to the development of cysts, sinuses and fistulas with great variability. We report about a 32 years old female who complains about an otorrhea of the left ear. The operative resection of an “outer ear canal fistula” fifteen years before stopped the otorrhea only for short time. Otoscopic examination showed a very small opening of the fistula at the bottom of the outer ear canal with no signs of inflammation. After injecting a contrast agent into the fistula the agent voided into the oral cavity. A CT scan showed a fistula between outer ear canal and the left oropharynx. After injecting a blue dye into the fistula an interior opening in the upper part of the left tonsil could be seen. Therapy of choice is the complete extraction of the fistula. This operation requires a wide opening, a lateral parotidectomy with dissection of the facial nerve and, under certain circumstances, even a mandibulotomy.

Due to the mild clinical symptoms surgeons tend to underestimate the surgical procedure. This might result in incomplete removal of the fistula, high recurrence rates or increased numbers of complications. Close anatomical relations between the anomaly, the parotid gland and the facial nerve make an intensive preoperative diagnostics indispensible. Patients need to be informed very well about an extended operation and possible complications.