Congenital fistulas of the pharynx: causes, symptoms, diagnosis, treatment

Congenital pharynx fistulas may be complete or incomplete. The first have a through nature: an external opening on the skin of the anterior or lateral surface of the neck, the second - a blind character: either an opening only on the skin with a fistulous course that ends in the tissues of the neck, or vice versa, only a hole on the side of the pharynx, also with a blind fistula in the tissues neck. Fistulous courses can be of different length and shape. The localization of their outer holes is extremely diverse. They can be located, starting from the area anterior to the outer edge of the sternocleidomastoid muscle, to the region of the hyoid bone or down to the sternum. In the latter case, such a hole is most often located 1-2 cm above the sternoclavicular joint. Less often such fistulous passages occur at the level of the larynx and very rarely - in the medial part of the neck, more often on the right. True middle fistulas are located strictly along the median line, as well as their fistulous course. These are blind fistulas that end with a bag (cyst) associated with the hyoid bone. Virtually all the pharynx fistulas are secondary, corresponding to the gill cysts of the thyroid gland. Complete medial fistulas are also observed, the inner opening of which is located in the region of the blind opening of the tongue; these fistulas represent a rudimentary formation of the embryonic thyroid-ligament canal. Also described fistula, located above the hyoid bone (there are also blind fistulas of the auricle, the holes of which open on the main curl - coloboma auris).

Congenital primary complete fistula refers to the true gill (bronchial) fistula, located below and lateral to the hyoid bone. As a rule, these skin holes of external fistulas are single and very narrow. They are covered with a crust, under which there is sometimes a small dot of granulation tissue.

The position of the internal opening of the full fistula is more constant and almost always located in the region of the palatine tonsils, behind the posterior palatine arch or less often at the level of the pharyngeal pocket. It is very narrow and visually virtually undefined. The communication between the two holes of the through (full) fistula is meandering and contains cavities, which prevents its probing. A thin probe can penetrate to the hyoid bone or to the angle of the lower jaw. When probing an external hole located above the hyoid bone, the probe encounters an obstacle on the bend of the fistulous course, which is almost always at the level of this bone. The trajectory of the course, beginning on the skin above the hyoid bone, passes through the dermis and superficial aponeurosis of the neck, deepens under the sternocleidomastoid muscle, reaches the hyoid bone, then enters the posterior abdomen of the digastric muscle and ends in the region of the palatine tonsils. Muscles shinohlotochnaya and silo-tongue cross the fistulous course superficially. It passes between the outer and inner carotid arteries, is soldered to the bed of these vessels, then crosses the hyoid and glossopharyngeal nerves, from which it receives nerve fibers.

With regard to the structure of the fistulous course, it has an external fibrous membrane, which in some cases contains muscle fibers or cartilaginous tissue. In the walls of medial fistulas that originate from the embryonic thyroid-ligament canal, it is often possible to meet the parenchymal tissue of the thyroid gland. The internal surface of the fistulous course covering the outer fibrous layer consists of a multilayer flat keratinizing epithelium or of a multi-layered non-coronary epithelium such as the oral mucosa, or even from a cylindrical epithelium with or without cilia like an embryonic pharyngeal esophageal mucosa.

Diagnosis of congenital throat swollen. The only symptom of congenital pharyngeal fistula with an external hole, which causes anxiety to the patient, is the discharge from the fistulous course of the droplet of a transparent watery or slightly viscous liquid, similar to saliva. However, during food intake, these discharges become abundant and lead to irritation of the skin around the fistula. In rare cases, with full fistulae, liquid foods can be released through them. During menstruation, these discharges can become bloody. Sometimes it is possible to palpate the fistula as a dense strand extending from the outer opening to the hyoid bone. When probing the fistula by a thin flexible probe, it usually reaches the hyoid bone, causing a cough or shortness of breath. Sometimes between the amygdala and the posterior arch, a fistula can be detected, manifested by a droplet of mucopurulent discharge.

The introduction into the fistula of methylene blue, milk or liquids with certain taste qualities (solutions of common salt, sugar, quinine), with a complete fistula can reach the pharynx and be detected visually or by the appearance of a certain taste sensation in the subject.

Radiography using contrasting materials can reveal a fistulous course with complete fistula, but incomplete deep fistulous passages with this method are practically not detected.

Treatment of congenital throat swollen. The previously used non-operative method, consisting of sclerosing liquids (solutions of iodine, silver nitrate, etc.), electro-caustic, electrophoresis, etc., did not bring the desired results. The only effective method of treatment is total fistula extirpation. However, such surgical intervention is very difficult, requiring appropriate skills and a good knowledge of the anatomy of the neck, because on his feet the surgeon meets large vessels and nerves. At the fistulas of the tongue-and-tongue canal around which the hyoid bone (transhoidal fistula) develops during embryogenesis, resect the body of this bone. However, often the consequences of such an operation in the form of cicatricial deformities of the pharynx and neck cause the patient more anxiety than the fistula itself.

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