Under one Throat fistula an incorrect development of the neck viscera is understood. This is a congenital damage.
What is a throat fistula?
Neck fistulas are associated with neck cysts. Doctors differentiate between lateral and median neck fistulas or neck cysts. While lateral fistulas develop on the side of the neck, median neck fistulas develop on the neck midline. There are also neck cysts on the arch of the gill.
causes
Neck fistulas or cysts are congenital, but the lateral form often does not show up until adulthood. The median neck fistula is usually located between the hyoid bone and the thyroid gland. As part of the embryonic development, it grows from parts of the thyroid duct that do not recede.
If the thyroid system descends from the base of the tongue, which later arises, in the caudal direction, this leads to the formation of a connection in the direction of the pharynx. This is the thyroglossal duct. If this duct cannot completely close again, a median cervical cyst will remain. If an infection causes a median neck cyst to break out in the outward direction, this leads to the formation of a median neck fistula.
The undesirable developments arise primarily in the region of the hyoid bone. It is believed that the hyoid bone hinders the descent. As a result, the connecting duct runs either in front of or behind the hyoid bone. A course through the hyoid bone is also possible.
Lateral neck fistulas or neck cysts are the remains of the gill furrows or gill arches. For this reason they are also called branchiogenic neck fistulas. The gill arches develop between the 4th and 8th week of development of the embryo in the pharynx region.
In most cases a remnant of the second branchial arch remains. As the neck develops, the second branchial arch grows over the third and fourth arches. This process creates the cervical sinus, a cavity that usually recedes completely in the further course.
However, if this is not the case, parts or a complete gear are left over. This duct can extend from the tonsil region over the soft parts of the neck along the artery of the neck to the outer skin. It usually ends in the lower section of the sternocleidomastoid muscle.
Symptoms, ailments & signs
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Most people have a neck fistula or cyst on the hyoid bone, which forms an arched bone in the front of the neck. A lateral neck fistula usually only becomes noticeable in adults in the form of a thickening of the neck. As a cyst, it is often alone, while as a fistula it has extensions.
These extend in different directions. This can include the tonsils (tonsils) or the region of the collarbone. Apart from the swelling, there are usually no symptoms of a throat fistula or cyst. In some patients, however, inflammation is possible, which in the worst case can even develop into a purulent abscess. Very rarely, even a malignant tumor develops on the bottom of the fistula.
Diagnosis & course
If the patient visits a doctor with his throat fistula, he or she first looks at the patient's medical history (anamnesis). He will also do a physical exam. A median neck fistula can usually be felt as a resilient swelling in the middle of the neck. In addition, there are up and down movements during the swallowing process.
75 percent of all median neck fistulas or neck cysts can be detected before the age of 6. During a sonography (ultrasound examination) it is possible to detect a cavity in which there is liquid. Under certain circumstances, pus secretion can also escape from the opening of the median cervical fistula.
A lateral neck fistula can be diagnosed through a small opening that is located on the anterior edge of the sternocleidomastoid muscle on the side of the neck. Purulent or milky secretion emerges. In unclear cases, further examinations such as computed tomography (CT) or magnetic resonance imaging (MRT) are carried out.
Because a lateral neck cyst or neck fistula can be mistaken for a benign or malignant tumor, a precise differential diagnosis is important. In most cases, the neck fistula can be completely removed by surgery.However, a recurrence of a fistula or cyst cannot be ruled out. This is especially true if a single section of the fistula has not been removed.
Complications
In most cases, the throat fistula only leads to symptoms in adulthood. However, it is usually innate and is not acquired in the course of life. The neck fistula primarily causes the neck to thicken. The cysts can extend in different directions and lead to severe swelling.
In addition to the swelling, there are usually no further complications or complaints. In these cases, no direct treatment of the neck fistula is necessary if it does not bother the patient. Not infrequently, however, an abscess occurs, which can also be purulent. Infections and inflammations can develop from this abscess, which is why treatment is necessary in this case.
It is rare that a tumor develops. The throat fistula is treated surgically and does not lead to further complications or complaints. As a rule, the entire fistula is removed so that the person concerned does not suffer from restrictions after the operation. The life expectancy is not restricted by the neck fistula. This also applies if the neck fistula is not treated.
When should you go to the doctor?
As a rule, a throat fistula should be examined and treated if it leads to symptoms. A throat fistula without symptoms does not need to be treated as it does not have a negative impact on the health of the person concerned. However, since a neck fistula can also significantly reduce the patient's aesthetics, it can be removed by a surgical procedure. A dermatologist should be consulted for this.
Regular examinations are also recommended for this disease in order to identify and remove a degeneration and thus a tumor at an early stage. The doctor should also generally be consulted if there is a swelling on the neck that cannot be explained by external factors. There are no particular complications with the treatment and the neck fistula can be easily removed. After the operation, the doctor should be consulted if the wound itchy or bleeding occurs. Severe pain is also rather unusual and should also be controlled.
Doctors & therapists in your area
Treatment & Therapy
Usually a throat fistula or cyst is treated surgically. Conservative therapy is possible, but is not considered to be promising. In addition, the malformations do not go away on their own, so that they cannot be remedied by conservative treatment. At the beginning of the operation, the patient is given either a local or general anesthetic.
If it is a median neck fistula, the surgeon will make an incision over the hyoid bone. He then removes the cyst along with a section of the hyoid bone. If there is a cervical fistula in the external direction, it is cut out in the form of a spindle. Since complete removal of the fistula is required, surgery is often required down to the initial portion of the tongue.
If there is a lateral neck cyst, the surgeon cuts the skin at the tension lines. He pushes the nodding muscle located there aside in order to be able to remove the cyst and any fistulas. For this purpose, several skin incisions are often necessary.
Outlook & forecast
If left untreated, the neck fistula leads to discomfort and discomfort as the patient ages. In severe cases, there are sequelae and other diseases. In addition to a tightness in the throat and swelling, the throat fistula can grow. Over time, there is a risk that the fistula will mutate and develop a tumor. With a malignant tumor there is a potential danger to life for the person concerned.
If treatment is used, the prognosis is favorable. The neck fistula is removed in a surgical procedure. Since the area around the neck is easily accessible to the surgeon, complications are rare. Normally, the patient is discharged from the treatment shortly after the surgical procedure as symptom-free.
The throat fistula can be diagnosed immediately after birth. However, surgery is rarely initiated within the first few days of life. The timing of the procedure is determined according to the necessity and the size of the fistula. With a small neck fistula, local anesthesia is sufficient, while a large neck fistula can only be removed under general anesthesia. In both cases, the patient should be in a stable state of health so that the healing process can take place as quickly as possible. A return of the neck fistula is not to be expected in the further course.
prevention
Neck fistulas are congenital disorders. Because of this, there are no preventive measures.
Aftercare
Follow-up care cannot aim to prevent the cervical fistula from recurring. Either it is present at birth or it is not. Surgical intervention usually takes place to remove the malformation. This usually results in a final recovery. The patient can lead a carefree life and does not have to attend any aftercare.
In rare cases, however, an operation does not work or does not work completely. Then there may be an increased susceptibility to infections and inflammation. Those affected must consult a doctor in the event of any acute symptoms. Sometimes a tumor also forms, which can turn out to be life-threatening.
Some doctors recommend avoiding an operation under general anesthesia or local anesthesia if there are no symptoms. Those affected can usually continue to live without symptoms for decades. Support in everyday life aimed at aftercare is not necessary. Only in old age do symptoms appear more often, which a doctor then treats acutely.
Follow-up care does not play an essential role in the case of a diagnosed neck fistula. Patients opt for either a symptom-free life with the foreign body or surgical removal. Doctors only recommend a presentation in the case of acute complaints.
You can do that yourself
Medical treatment for a throat fistula can be promoted by a number of measures. First of all, bed rest and rest for those affected. The body is particularly weakened after the operation, which is why excessive exertion should be avoided initially.
In addition, dietary steps must be taken, which depend on the respective operation and can be quite different. The operating doctor will suggest a suitable diet to the patient for the time before and after the operation and give further tips for a speedy recovery. Above all, the patient must observe the wound and take good care of it. Any abnormalities such as sudden itching, bleeding or pain should be clarified immediately.
If you have multiple neck fistulas, you may need follow-up support. It is advisable to consult a person you trust or qualified nursing staff at an early stage in order to avoid complications in the healing phase. A few remedies from homeopathy are helpful. Including the preparation Apis D200 or the remedy Apis mellifica, which helps with swelling and redness. A suitable Schüßler salt is preparation number 4, potassium chloratum. The use of these preparations should always be made in consultation with the responsible doctor.
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