Fistulograms for the management of recurrent and atypical congenital neck anomalies.

BACKGROUND

Fistulous and cystic neck lesions that cannot be categorized into traditional classification schemes at presentation are challenging to manage and often manifest as recurrently draining fistulas after primary surgery. Work up with traditional cross-sectional imaging techniques with computed tomography (CT) or magnetic resonance imaging (MRI) may not provide adequate fine details of small channels. Characterization of fistula tracts is necessary for identification and definitive management of atypical or recurrent congenital neck anomalies.

METHODS

A retrospective review of the electronic medical record from 2 institutions between 2016 and 2023 identifying cases of atypical or recurrent congenital neck anomalies for which CT and MR fistulogram, a novel interventional imaging technique, identified and characterized atypical fistula tracts. Imaging protocol, fistulogram technique, imaging-anatomic correlation, and follow up are reported.

RESULTS

We identified 5 patients aged 8-14 years who presented with a draining pit in the head and neck who underwent CT or MRI fistulograms. Diagnoses include first branchial cleft anomalies (n = 3), deep branchial cleft fistula containing ectopic salivary tissue (n = 1), and a recurrent thyroglossal duct cyst (n = 1). Three patients had prior surgery to address these anomalies with recurrences, and one patient had an associated Kabuki syndrome. Complete resection was performed in all cases, with no recurrence to date.

CONCLUSION

CT and MRI fistulograms are minimally invasive, safe, efficacious, and feasible techniques that can be performed before surgery and facilitated on the same day in a single anesthesia encounter. The technique allows for complete visualization of atypical and/or recurrent cystic and fistulous neck anomalies. It facilitates preoperative planning and aids in the characterization of the lesion so that a complete surgical excision can be executed.