BRANCHIAL FISTULA/ SINUS:-

• Branchial fistula/ sinus is a congenital anomaly i.e. present from birth due to persisitence of branchial apparatus remnants.
• This is a tiny hole in the lower part of the neck formed by incomplete closure of the second branchial arch. The sinus is frequently associated with a track running up the neck, often as high as the posterior pillar of the fauces in the pharynx (so forming a branchial fistula).
• The condition is normally observed in children, most often in the first year of life. It presents as a small orifice discharging mucous in the anterior border of the sternomastoid, one-third of the way up from the muscle's origin.
• Treatment is surgical excision, dissecting the fistula out as high as possible. More than one incision may be necessary despite the presence of a single, small hole observable as depicted in the following operative procedure:-

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GLOMUS VAGALE:-

• Glomus vagale tumor arises from paraganglia in and around the Xth Cranial Nerve or Vagus nerve.
• Tumors of the paraganglia are called "paragangliomas," "glomus tumors," and "chemodectomas."
• Paraganglia are normal structures that develop from the neural crest; they accompany cranial nerves and cluster around cranial nerve ganglia.
• Most common paraganglioma of neck are Carotid body tumour and next is Glomus Jugulare tumours. Glomus vagale tumours are third common most.
• Most glomus vagale tumours manifest as painless swelling in neck near angle of lowe jaw bone or mandible.
• Glomus vagale tumors cause other lower cranial neuropathies: Hoarseness of voice, dysphagia, palatal weakness, and tongue hemiatrophy. Pressure on the cervical sympathetic chain causes Horner syndrome.
• Embolisation followed by surgery is the best treatment choice.
• When surgery is not possible then therapeutic embolisation and radiotherapy are best alternatives.

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