A throat fistula is an abnormal development of the cervical viscera. This is a congenital defect.
What is a cervical fistula?
Cervical fistulas are associated with cervical cysts. Doctors distinguish between lateral and median neck fistulas or neck cysts. While lateral fistulas develop in the side area of the neck, median cervical fistulas develop on the midline of the neck. In addition, there are cervical cysts on the gill arch.
Cervical fistulas or cervical cysts are congenital, but often do not appear until adulthood in the lateral form. The median cervical fistula is usually located between the hyoid bone and the thyroid. It grows during embryonic development from parts of the thyroglossal duct that do not regress.
If the thyroid system descends from the base of the tongue, which develops later, 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 close completely again, this will result in a median neck cyst remaining. If an infection causes a median cervical cyst to rupture in the external direction, this will result in the formation of a median cervical fistula.
The malformations occur primarily in the region of the hyoid bone. It is believed that the hyoid bone interferes with the descent. As a result, the connecting passage runs along either in front of or behind the hyoid bone. A course through the hyoid bone is also possible.
Lateral cervical fistulas or cervical cysts are the remnants of the gill sulci or gill arches. For this reason they are also called branchiogenic neck fistulas. The formation of the gill arches occurs between the 4th and 8th week of embryo development in the pharyngeal region.
In most cases, a remnant of the second gill arch remains. As the neck develops, the second gill arch grows over the third and fourth arches. This process creates the cervical sinus, a cavity that usually disappears completely in the further course.
However, if this is not the case, parts or a complete course remain. This duct can extend from the tonsil region via the soft tissues 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
A throat fistula, or throat cyst, is found in most people on the hyoid bone, which forms an arch-shaped bone in the front of the neck. A lateral neck fistula usually only becomes noticeable in adults in the form of a thickened neck. As a cyst, it is often found alone, while as a fistula it has extensions.
These extend in different directions. This may include the tonsils or the region of the collarbone. Apart from the swelling, there are usually no symptoms associated with a fistula or cyst in the neck. In some patients, however, inflammation is possible, which in the worst case even develops into a purulent abscess. Very rarely even a malignant tumor develops at the bottom of the fistula.
Diagnosis & History
If the patient visits a doctor with his neck fistula, he first deals with the medical history (anamnesis) of the patient. He will also do a physical exam. A median cervical fistula can usually be felt as a firm, elastic swelling in the middle of the neck. In addition, there are up and down movements during the swallowing process.
75 percent of all median cervical fistulas or cervical 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 cervical fistula can be diagnosed through a small opening located at the anterior border of the sternocleidomastoid muscle on the lateral portion of the neck. A purulent or milky secretion emerges. In unclear cases, further examinations such as computed tomography (CT) or magnetic resonance imaging (MRI) are carried out.
Because a lateral neck cyst or neck fistula can be confused with a benign or malignant tumor, a precise differential diagnosis is important. In most cases, the neck fistula can be completely eliminated by surgery. However, the recurrence of a fistula or cyst cannot be ruled out. This is especially true if a single section of the fistula has not been surgically removed.
In most cases, the neck fistula only causes symptoms in adulthood. However, it is usually congenital and is not acquired in the course of life. The neck fistula primarily causes a thickening of the neck. The cysts can extend in different directions and thus lead to severe swelling.
Apart from the swelling, however, there are usually no other complications or symptoms. In these cases, no direct treatment of the cervical fistula is necessary if it does not bother the patient. Not infrequently, however, an abscess occurs, which can also be purulent. Infections and inflammation can develop from this abscess, which is why treatment is necessary in this case.
Rarely does this lead to the formation of a tumour. The treatment of the neck fistula is surgical and does not lead to further complications or complaints. As a rule, the entire fistula is removed so that the affected person does not suffer from any restrictions even after the operation. Life expectancy is not limited 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 fistula in the neck should be examined and treated if it causes symptoms. A throat fistula without symptoms does not need to be treated because it does not have a negative effect on the health of the person affected. However, since a neck fistula can also significantly reduce the patient’s aesthetics, it can be surgically removed. A dermatologist should be consulted for this.
Regular examinations are also recommended for this disease in order to detect and remove a degeneration and thus a tumor at an early stage. The doctor should also be consulted in general when there is swelling in the neck that cannot be explained by external factors. There are no special complications during the treatment and the fistula in the neck can be easily removed. After the operation, the doctor should be consulted if the wound is itchy or bleeding. Severe pain is also uncommon and should be controlled as well.
Treatment & Therapy
A fistula or cyst in the neck is usually treated surgically. Conservative therapy is possible, but is not considered promising. In addition, the malformations do not go away on their own, so they cannot be corrected by conservative treatment. At the start of the operation, the patient is given either local or general anesthesia.
If it is a median fistula, the surgeon makes an incision in the skin over the hyoid bone. Then he removes the cyst along with a section of the hyoid bone. If there is a cervical fistula in the external direction, it is excised in the form of a spindle. Because complete removal of the fistula is required, surgery to the initial portion of the tongue is often necessary.
If there is a lateral neck cyst, the surgeon cuts the skin at the tension lines. He pushes aside the head nodding muscle located there in order to be able to remove the cyst and any fistulas. For this purpose, several skin incisions are often necessary.
Outlook & Forecast
Left untreated, cervical fistula leads to discomfort and discomfort as the patient ages. In severe cases, there are sequelae and other diseases. In addition to a feeling of tightness in the throat and swelling, the fistula in the neck can grow. There is a risk over time that the fistula will mutate and a tumor will develop. In the case of a malignant tumor disease, there is a potential danger to life for those affected.
If treatment is sought, the prognosis is favorable. The neck fistula is surgically removed. Since the neck area is easily accessible for the surgeon, complications are rare. Normally, the patient is discharged from treatment a short time after the surgical intervention as symptom-free.
The neck fistula can be diagnosed immediately after birth. However, surgery is rarely initiated within the first few days of life. The time of the intervention is determined according to necessity and the size of the fistula. A local anesthetic is sufficient for a small fistula in the neck, while a large fistula in the neck 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 recurrence of the neck fistula is not to be expected in the further course.
Neck fistulas are congenital disorders. Because of this, there are no preventive measures.
Follow-up care cannot aim to prevent the neck fistula from reoccurring. Either it is present at birth or it is not. There is usually an operation to remove the deformity. This usually results in a final recovery. The patient can live a carefree life and does not have to attend any follow-up care.
In rare cases, however, an operation is unsuccessful or not entirely successful. Then there can be an increased susceptibility to infections and inflammation. Those affected must consult a doctor in the event of any acute symptoms. Sometimes a tumor forms, which can prove to be life-threatening.
Some doctors advise not to undergo an operation under general or local anesthesia if you are symptom-free. Those affected can usually live symptom-free for decades. Support in everyday life aimed at aftercare is not necessary. Only in old age do complaints occur more frequently, which a doctor then treats acutely.
Follow-up care therefore plays no significant role in the case of a diagnosed cervical fistula. Patients decide either to live with the foreign body without any symptoms or to have it surgically removed. Doctors only recommend an appointment if you have acute symptoms.
You can do that yourself
The medical treatment of a fistula in the neck can be promoted by a number of measures. First of all, bed rest and rest apply to those affected. The body is particularly weak after the surgical procedure, which is why excessive exertion should be avoided at first.
In addition, dietary steps must be taken, which depend on the particular operation and can vary quite a bit. The doctor who performed the operation will suggest a suitable diet for the patient before and after the operation and give other tips for a speedy recovery. Above all, the patient must observe the wound and take good care of it. Abnormalities such as sudden itching, bleeding or pain should be clarified immediately.
If there are several neck fistulas, support with follow-up care may be required. It is advisable to consult a person you trust or professional nursing staff at an early stage in order to avoid complications during the healing phase. There are some homeopathic remedies that can help. These include the preparation Apis D200 or the remedy Apis mellifica, which helps with swelling and redness. A suitable Schuessler salt is preparation number 4, potassium chloratum. These preparations should always be used in consultation with the doctor responsible.