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Clinical Problem Solving: Radiology
November 2001

Diagnosis Radiology Quiz Case 2

Author Affiliations
 

R. NICKBRYANMDS. JAMESZINREICHMD

Arch Otolaryngol Head Neck Surg. 2001;127(11):1396. doi:

In this case, the patient presented with a fistula of the second branchial cleft. In its lower third, a second branchial cleft fistula and sinus is encountered along the anterior border of the sternocleidomastoid muscle and may be bilateral. Typically, the second branchial cleft fistula runs deep to the platysma muscle, ascends along the carotid sheath, and crosses over the hypoglossal and glossopharyngeal nerves and stylopharyngeus muscle. It typically ends in the upper half of the posterior faucial pillar, the supratonsillar fossa, or directly on the tonsillar surface.1 A complete branchial fistula with external and internal openings, as in the case reported herein, is rare. Cysts may exist independently or anywhere along the course of the sinus or fistula.

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