Name of the Procedure:

Excision of Branchial Cleft Cyst, Vestige, or Fistula (Extending Beneath Subcutaneous Tissues and/or into Pharynx)

Summary

This surgical procedure involves the removal of a branchial cleft cyst, vestige, or fistula that extends beneath the skin and into the pharynx. These are congenital abnormalities in the neck area that can cause infections or discomfort.

Purpose

The procedure addresses congenital anomalies such as branchial cleft cysts, vestiges, or fistulas. The goals are to prevent recurrent infections, alleviate discomfort or pain, and eliminate any associated disfigurement.

Indications

• Recurrent neck infections.
• Presence of a palpable or visible cyst or fistula in the neck.
• Discomfort or cosmetic concerns associated with the cyst or fistula.

Preparation

• Patients may need to fast for several hours before the procedure.
• Medication adjustments, such as stopping blood thinners.
• Pre-operative imaging studies like ultrasound or MRI to assess the extent of the anomaly.

Procedure Description

1. The patient is positioned and prepped in a sterile manner.
2. General anesthesia is administered.
3. An incision is made over the site of the cyst or fistula.
4. The surgeon carefully dissects the tissue to fully excise the cyst or fistula.
5. In cases where the anomaly extends into the pharynx, additional careful dissection is required.
6. The area is thoroughly inspected for any remaining tissue.
7. The incision is closed with sutures.
8. A drain may be placed to prevent fluid accumulation.

Duration

The procedure typically takes 1 to 3 hours, depending on the complexity and extent.

Setting

The procedure is performed in a hospital or surgical center.

Personnel

• Surgeons specialized in otolaryngology (ENT).
• Anesthesiologists.
• Surgical nurses and support staff.

Risks and Complications

• Common risks: bleeding, infection, and scarring.
• Rare risks: damage to nearby structures (nerves, blood vessels), recurrence of the cyst or fistula, and anesthesia-related complications.

Benefits

• Elimination of recurrent infections.
• Relief from pain or discomfort.
• Improved cosmetic appearance.

Recovery

• Patients may be observed for a few hours up to overnight, depending on their condition.
• Instructions include wound care, pain management, and activity restrictions.
• Follow-up appointments to monitor healing and remove sutures, if necessary.
• Most patients can return to normal activities within 1-2 weeks.

Alternatives

• Observation for minor, asymptomatic cases.
• Aspiration of cyst contents for temporary relief.
• Pros: Less invasive and may not require surgery immediately.
• Cons: High likelihood of recurrence and potential for infections.

Patient Experience

• Patients typically feel drowsy and may experience some discomfort initially.
• Pain is managed with prescribed medications.
• Most patients feel significantly better within a few days to a week post-procedure, with full recovery expected in a few weeks.