An effective surgical technique for the excision of first branchial cleft fistula: make-inside-exposed method by tract incision.

The objective of the study was to evaluate the effectiveness of make-inside-exposed method by tract incision to remove the first branchial cleft fistula, while avoiding injury to the facial nerve and completely excising the fistula. Fifteen patients who underwent the make-inside-exposed method by tract incision for excision of the first branchial cleft anomalies were reviewed. Pre-auricular fistulas or sinuses occurred in nine of them, and post-auricular fistulas occurred in six cases. The symptoms of these patients, post-operative complications including facial nerve paralysis and recurrence of the lesion, were observed. Of the 15 patients, 6 had undergone previous incision and drainage of abscess for the infected fistulas. All patients had swelling or suppuration in the pre-auricular or post-auricular region. Post-auricular fistulas had intimate relationship with facial nerves in most of the cases (5/6). The fistulas or sinuses tracts were all removed completely without any complications, such as facial palsy, but severe scar formation occurred in one case. No remnant of fistula or sinus was observed during the follow-up period from 2 to 12 years postoperatively. Make-inside-exposed method by tract incision is an effective and safe technique for the excision of the first branchial cleft fistula. The two main advantages of this method are that it can preserve the facial nerve safely and excise the fistulas completely. However, skillful microsurgery manipulation is necessary.