After some children are born, there will be small holes the size of pinpoints behind the ears or in the neck, these small holes will sometimes discharge foul-smelling liquid, and there may be hard lumps in the deep part of it when touched, and once infected, it will appear red, swollen, hot and painful, and even suppurated, which may be gill cleft cysts and fistulas......
Gill cleft cysts and fistulas are congenital malformations that occur between the auricle and the collarbone, usually located in the head and neck of a person. Among them, if there are openings at both ends of the skin of the pharynx and neck, it is called "fistula", and if there is an opening at one end of the pharynx or neck skin, it is called "sinus tract" or "incomplete fistula".
Gill cleft cysts and fistulas are congenital developmental abnormalities that persist after birth and generally do not affect health. Gill cleft fistula often has yellowish-white or okara-like discharge at the external fistula of the neck, and secondary infection may cause congestion, redness, swelling, and purulent discharge of the skin around the external fistula.
Branchial cleft cysts are generally asymptomatic and appear as painless masses on the side of the neck, which tend to increase in size gradually, or may be large and sometimes small, and rapidly increase in size when infection occurs, accompanied by symptoms such as fever and local tenderness.
First branchial cleft fistula and cyst
The first branchial cleft fistula, also known as the auricular and cervical fistula, opens in the anterior or posterior part of the earlobe, or near the angle of the mandible, and the internal fistula is located in the external auditory canal. The fistula runs underneath the eustachian tube, behind the tensor palatine muscle, and in front of the carotid artery or stylpharyngeal muscle, and is closely related to the facial nerve, the posterior cranial nerve, and the internal jugular arteries and veins.
Second branchial cleft fistula and cyst
The skin opening is located in the middle and lower 1/3 of the anterior edge of the sternocleidomastoid muscle, penetrates the deep platysma muscle, ascends along the carotid sheath, between the internal and external carotid arteries, passes through the superficial surface of the hypolingual, glossopharyngeal nerve and stylpharyngeal muscle, and reaches the tonsillar fossa at the styloid ligament and the lower abdomen of the posterior abdomen of the digastric muscle, and the posterior edge of the hyoid bone.
Third branchial cleft fistula and cyst
The cutaneous opening is the same as the second branchial cleft fistula, the fistula is located deep in the platysma muscle, ascends along the carotid sheath, travels along the vagus nerve, crosses the hypoglossal nerve, is below the glossopharyngeal nerve or stylpharyngeal muscle, bypasses the posterior and deep part of the internal carotid artery, crosses the thyrohyoid membrane between the hyoid bone and the superior laryngeal nerve, and terminates at the internal piriformis fistula.
Fourth branchial cleft fistula and cyst
Most of them are sinus tracts, and there are few fistulas. The location of the external fistula is about the same as that of the second and third branchial fissure fistulas, and the internal fistula is mostly located in the upper esophagus. From the outside to the inside, the anterior border of the sternocleidomastoid muscle ascends to bypass the hypoglossal nerve, then descends to the posterior common carotid artery, bypasses the subclavian artery (right) or the aortic arch (left), and ascends along the tracheoesophageal sulcus parallel to the recurrent laryngeal nerve behind the thyroid gland to reach the internal fistula. Piriform fossa fistulas include the traditional concept of third and fourth branchial fissure fistulas.
Pathways of treatment
Open surgery on the neck approach to complete removal of a fistula or cyst is the traditional curative treatment, and surgery should be performed after inflammation has been controlled in patients with pre-existing infection.
Once a branchial cleft cyst is found, it needs to be treated with surgery. For asymptomatic branchial cleft fistula, it may not cause symptoms for a long time, so you can pay close attention to the changes in the condition and do not need surgery for the time being.
Patients with repeated infections caused by fistulas, or patients whose secretions do not flow out easily and accumulate cysts, as well as patients who cause uncomfortable symptoms, should be treated promptly.
General Surgery
Feng Liang: Chief physician, good at the diagnosis and treatment of pediatric general surgery and neonatal surgical diseases, especially in the diagnosis and treatment of pediatric abdominal surgery and pediatric hernia surgery.
Visiting hours: [Honggutan Campus] every Tuesday morning, every Friday morning for special outpatient services
Deng Qingqiang: Director of the Department of General Surgery, Chief Physician, specializing in the diagnosis and treatment of pediatric general surgery and neonatal surgical diseases such as abdominal diseases, soft tissue infections, trauma, tumors, neck cysts and fistulas. In particular, he has rich clinical experience in the operation of pediatric minimally invasive laparoscopic techniques for diseases in the general direction, and has carried out minimally invasive treatment of complex diseases such as hiatal hernia, common bile duct cyst, and Hirschsprung disease earlier in the province.
Visiting time: [Honggutan Campus] every Wednesday afternoon, every Thursday morning for special outpatient services
Xu Wei: Director of the Day Ward, Chief Physician, good at the diagnosis and treatment of common pediatric diseases, especially in pediatric oblique hernia, hydrocele, ovarian cyst, cervical fistula, abdominal diseases, etc.
Visiting hours: [Honggutan Campus] every Wednesday morning, [Honggutan Campus] every Monday morning for special outpatient services
Lei Bin: Chief physician, good at the diagnosis and treatment of common pediatric diseases, especially in the diagnosis and treatment of abdominal diseases, soft tissue infections, trauma, tumors, neck cysts and fistulas.
Visiting hours: [Donghu Campus] all day every Monday, [Honggutan Campus] special outpatient clinic every Wednesday morning
Zhang Shouhua: Deputy Director of the Department of General Surgery, Deputy Chief Physician, Ph.D., specializing in the diagnosis and treatment of common diseases in pediatric general surgery and pediatric oncology surgery. In particular, neuroblastoma, rhabdomyosarcoma, Wilms tumor, hepatoblastoma, hamartoma, abdominal teratoma, ovarian tumor, mesenteric cyst and omentum cyst, spleen tumor, gastrointestinal tumor, hemangioma, lymphangioma and other mass diseases are diagnosed and treated. He has high scientific research and clinical experience in the comprehensive treatment of pediatric solid malignant tumors such as surgery, chemotherapy, radiotherapy, intervention, immunization, and targeting.
Visiting hours: [Honggutan Campus] every Tuesday afternoon, [Honggutan Campus] every Thursday all day
Lei Jun: Deputy Chief Physician, specializing in the diagnosis and treatment of abdominal diseases, soft tissue infections, trauma, tumors, neck cysts and fistulas. In particular, he has deep experience in the minimally invasive surgical treatment of retrosternal hernia, diaphragmatic hernia (posterolateral), diaphragmatic bulge, megacolon, hiatal hernia, common bile duct cyst and other diseases.
Visiting hours: [Honggutan Campus] every Friday all day, [Donghu Campus] every Thursday all day
Chen Weilong: Deputy Chief Physician, specializing in the diagnosis and treatment of abdominal diseases, soft tissue infections, trauma, tumors, neck cysts and fistulas. In particular, he has deep attainments in the diagnosis and treatment of common bile duct cyst, hiatal hernia, ovarian mass, inguinal oblique hernia and other diseases through laparoscopic treatment.
Visiting hours: [Honggutan Campus] all day every Monday, [Donghu Campus] all day every Friday
Note: The visiting time is for reference only, please refer to the registration schedule on the hospital's WeChat platform for details.
Source: Jiangxi Provincial Children's Hospital
Correspondents: Yang Zhiyun, Luo Ying, Wei Meijuan
Editor: Huang Menglin
Reviewer: Chen Shirui
Issued: Daley Red
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