branchial cleft fistula
Introduction
Introduction to splitting fistula The fistula fistula is the external fistula of the fistula sac, the sulcus or the sulcus does not disappear, and the whole fistula is formed. Because the fistula is located in the neck, it is also called the cervical sacral canal. The first cleft palate is accompanied by pus in the ear. The second, third, and fourth iliac crested iliac crests have an external sac in the 1/3 and 1/3 of the anterior aspect of the sternocleidomastoid muscle. The tonsil fossa and the upper end of the esophagus have an internal fistula, and the palpation is upward along the external sac. It has a solid cord. Cysts or fistulas are stratified squamous epithelium, occasionally other epithelial components, connective tissue envelope outside the epithelial layer, easy to separate during surgery, cystic epithelium, mucus and pus, often with cholesterol crystals. The etiology of this disease is not clear, and may have certain correlation with environmental factors, genetic factors, dietary factors, and mood and nutrition during pregnancy. Therefore, it is impossible to directly prevent the disease against the cause. Early detection, early diagnosis, and early treatment are important for indirect prevention of this disease, and can also reduce the incidence of infection complications. For patients with existing infections, antibiotics should be used as soon as possible. basic knowledge Sickness ratio: 0.001%-0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: bad breath, purulent mumps, parotid gland infection
Cause
Cause of cleft palate
Cause (60%):
1 The diaphragm between the sulcus and the sac is broken;
2 sulcus closure is not complete;
3 organ epithelial residue;
4 organ development abnormalities;
5 The cervical sinus is not closed, and one or more of the above factors may exist at the same time.
Prevention
Split fistula prevention
The etiology of this disease is not clear, and may have certain correlation with environmental factors, genetic factors, dietary factors, and mood and nutrition during pregnancy. Therefore, it is impossible to directly prevent the disease against the cause. Early detection, early diagnosis, and early treatment are important for indirect prevention of this disease, and can also reduce the incidence of infection complications. For patients with existing infections, antibiotics should be used as soon as possible.
Complication
Chapped fistula complications Complications, bad breath, purulent mumps, parotid gland infection
As the patient's skin integrity is destroyed and secretions continue to flow from the fistula, clinically often complicated infections, skin integrity is destroyed, usually secondary to low constitution, or long-term use of immunosuppressive agents and fungal infections such as nail fungus Patients, such as concurrent bacterial infections, may have symptoms such as fever, swelling of the skin, ulceration, and purulent secretion. Severe cases can lead to sepsis, which should be brought to the attention of clinicians.
Symptom
Cleft palate symptoms common symptoms in the ear, pus, abdomen, flank, local cyst, bad breath
Cysts or fistulas are stratified squamous epithelium, occasionally other epithelial components, connective tissue envelope outside the epithelial layer, easy to separate during surgery, cystic epithelium, mucus and pus, often with cholesterol crystals.
classification
According to the different sources of embryonic development of the cleft palate, it can be divided into the following four types:
(a) the first cracked fistula
It is rare in clinical practice. The external fistula is located at the lower back of the mandibular angle, close to the leading edge of the upper end of the sternocleidomastoid muscle, the neck side skin above the hyoid bone, and the medial malleolus is located in the cartilage or auricle of the external auditory canal. In front of or behind the tympanic cavity and eustachian tube, the fistula is under the eustachian tube, behind the sacral muscle, behind the carotid or styloid pharyngeal muscles, and some are close to the facial nerve.
(2) The second splitting fistula
It is more common in clinical practice. The external fistula is located in the middle of the anterior border of the sternocleidomastoid muscle. At the junction of the lower third of the iliac crest, the fistula can pass through the platysma from the external fistula, and ascend along the carotid sheath, through the neck and outside the neck. Between the arteries, through the shallow surface of the glossopharyngeal nerve, the styloid pharyngeal muscle and the hypoglossal nerve, reach the upper part of the tonsil fossa, where the inner sac is located.
(3) The third cracked fistula
Less common, the lateral fistula is located in the lower part of the anterior border of the sternocleidomastoid, similar to the position of the external fistula of the second fissure fistula. The fistula passes through the deep part of the platysma, passes through the posterior aspect of the internal carotid artery, along the vagus nerve. On the superficial line, across the hypoglossal nerve, ending in the inner mouth of the pear-shaped fossa.
(4) The fourth cracked fistula
Rarely, the external fistula is similar to the second fissure fistula. The fistula passes deep into the platysma, descends along the carotid sheath to the chest, and then rises below the subclavian artery or aortic arch to the neck, ending at the upper end of the esophagus. .
Clinical manifestation
The first cleft palate is mainly characterized by pus in the ear, and there is a mass below the mandibular angle. The secretion of the ear is increased, and the secondary infection may cause pain and fever.
The second, third, and fourth cleft palate have a fistula on the anterior border of the sternocleidomastoid muscle. Sometimes the fistula is very thin, such as a needle tip or a small depression. There is often a little secretion in this place, and the patient often feels a stench in the mouth.
Examine
Cleavage fistula examination
Clinical physical examination: for the pus in the ear, there is a mass below the mandibular angle, the secretion of the ear is increased, secondary infection can cause pain, fever and other symptoms. The third and fourth cleft palate have a fistula on the anterior border of the sternocleidomastoid muscle. Sometimes the fistula is very thin, as thin as a needle tip or a small depression. There is often a little secretion in this place, and the patient often feels odor in the mouth.
Laboratory examination: X-ray iodine angiography through the mouth can be clearly diagnosed.
Diagnosis
Diagnosis and diagnosis of cleft palate
diagnosis
According to the medical history and typical clinical manifestations, it is easy to make a diagnosis. The first cleft palate is accompanied by pus in the ear, which is easily misdiagnosed as suppurative otitis media. Therefore, the identification of the two should be noted. The second, third, and fourth cleft palate are in the chest lock. The anterior margin of the mastoid muscle is at the junction of 1/3 and 1/3 of the rim, surrounded by an external fistula, tonsil fossa, pear closed fossa, and there is an internal fistula at the upper end of the esophagus. The palpation is upward along the external fistula, and a solid strip can be touched. The cord is passed to a high place, and X-ray iodine angiography is performed through the fistula to confirm the diagnosis.
Differential diagnosis
According to the clinical manifestations of this disease should be differentiated from tuberculous fistulas in the neck, actinomycosis.
1. Tuberculous fistula of the neck: This disease usually has a history of infection of lymph node tuberculosis. Because the tuberculosis destroys the tissue, it forms a cold abscess. When the tuberculosis is broken, the fistula often fails for a long time, and the acid-fast staining of the secretion can be distinguished.
2, actinomycosis disease: This disease is caused by the infection of actinomycetes, according to the examination of secretions can be clearly distinguished.
