From Sinus to Fistula: The Hidden Cost of Repeated Incision and Drainage in Paediatric Branchial Cleft Anomalies, a Case Series

Branchial cleft anomalies commonly present as branchial cleft sinuses, which are epithelialized tracts that communicate with the skin or pharynx. While these anomalies are often asymptomatic, they can become complicated by infection, resulting in abscess formation. The standard management of an infected branchial cleft sinus involves prompt incision and drainage (I&D) to alleviate symptoms and control infection. However, repeated I&D procedures without early definitive surgical intervention to address the underlying anomaly may lead to significant preventable complications such as sinus-to-fistula transformation, chronic discharge, and substantial psychosocial morbidity, particularly in children. This case series describes two children with a history of recurrent lateral neck swellings that initially lacked any external openings. Both underwent multiple I&D procedures before presenting with fluid extrusion from newly formed cutaneous openings, which led to social distress, including peer ridicule. Definitive surgical excision was performed via an external approach, resulting in complete symptom resolution at the six-month follow-up. Early recognition, timely specialist referral and definitive management are key to minimising physical and psychosocial morbidity in branchial cleft fistulae.