Abstract
A 66-year-old male presented progressive pharyngalgia, odynophagia, and lockjaw with swelling around the palatine tonsil and upper and lateral cervical lesions on the left side. CT scan revealed a peritonsillar abscess on the left side that extended to the parapharyngeal, retropharyngeal and anterior cervical spaces with phlegmone of the anterior neck and chest. Fiberscopic findings indicated that the lateral pharyngeal wall, epiglottis and ary-epiglottic fold were edematous with redness of a degree near to obstructing the supraglottic space. After emergent tracheotomy, surgical drainage was performed under local anesthesia. His conditions were improved gradually by cleaning the drained spaces with saline and intravenous administrations of antibiotics. However, on the 29th post-operative day, severe pharyngalgia reoccurred with abscess formation only in the posteroinferior lesion of the peritonsillar space. In response, surgical drainage of the abscess and tonsillectomy on the left side were then performed. After the tonsillectomy, a branchial fistula through the superior pharyngeal constrictor muscle was detected in the tonsillar fossa, and the branchial fistula was removed. Pathological study revealed that the inner structure of the branchial fistula was lined with stratified squamous epithelium. After the surgery, his symptoms have not recurred for six years.
