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Branchial Fistula

A *branchial fistula* is an abnormal connection (or passage) that forms between the skin and the inside of the neck, often as a result of a developmental anomaly in the branchial apparatus during embryonic development. The branchial apparatus includes structures that give rise to parts of the neck and face, and abnormalities in its development can lead to congenital defects like branchial fistulas. Types: *Branchial fistulas* are typically associated with the second branchial arch, but they can occasionally involve other arches (first, third, or fourth). *Second branchial fistula* is the most common type and usually presents as an opening in the skin near the angle of the jaw or on the neck. It may connect to the pharynx or tonsillar area. Causes: **Embryological development**: During fetal development, the branchial arches form structures that eventually develop into parts of the head and neck. A fistula forms when there is a failure of the normal closure of the branchial clefts or pouches. Symptoms: A visible *hole or pit* on the skin, usually on the side of the neck or under the ear. *Discharge of fluid or pus* from the opening, which could be related to an infection. Pain or swelling in the area if an infection occurs. Difficulty swallowing (if the fistula is connected to the pharynx). Diagnosis: **Clinical examination**: A doctor may be able to identify a branchial fistula based on its location and symptoms. **Imaging tests**: In some cases, CT scans or MRI can be helpful to evaluate the size and extent of the fistula. **Contrast studies**: Sometimes, a contrast agent can be injected into the fistula to see the path it follows. Treatment: *Surgical removal* is the most common treatment, as branchial fistulas do not typically close on their own. The surgery involves removing the fistula tract to prevent recurrent infections or complications. **Antibiotics**: If the fistula becomes infected, antibiotics may be prescribed before surgery. Without treatment, recurrent infections and complications can arise. It's important to seek medical attention if a branchial fistula is suspected.