The novel use of a pedicled submental flap in the treatment of recurrent fourth branchial cleft anomalies in the pediatric population

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Conference Proceeding

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OBJECTIVES: Fourth branchial cleft anomalies are rare and can present in a variety of ways in the head and neck. Limited data exists on the treatment of complex recurrent fistulas. We present a unique case utilizing a pedicled submental flap in the management of a persistent fourth branchial anomaly and discuss the use of pedicled flaps in the pediatric population. Study Design: Retrospective chart review. Methods: Patient data were collected from a tertiary care pediatric hospital medical record. Results: An 8 year old patient presented to our institution with a history of recurrent left neck infections and multiple failed incision and drainage procedures. Aggressive surgical options failed. She eventually underwent a complete resection of the fistula with partial pharyngectomy, left selective neck dissection, and two layered closure of the pharyngotomy defect with an oversewn pedicled submental island flap. The surgery was uneventful and the patient is without evidence of recurrence 7 months postoperatively. Conclusions: Treatment options for fourth branchial anomalies include incision and drainage, endoscopic cauterization via direct laryngoscopy or open neck surgery with complete sinus tract excision and thyroidectomy. Persistent disease requires aggressive management with partial pharyngectomy with/without the use of additional soft tissue for coverage. For significant pharyngeal defects, submental pedicled flaps can be utilized in repair and closure. To our knowledge this is the first reported case of a pedicled submental flap for closure of a pharyngotomy defect in the pediatric population. The use of the submental flap in this group is feasible, with few to no complications, and offers very acceptable cosmesis.

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