More On Brachial Cleft Fistula

This was originally written on Tuesday, June 24, 2008:

At 9.5 weeks old Logan's black eyes have turned brown--and they're my color! :) We could tell right away they weren't going to be green (the only other option since my dad and Joe's mom have green eyes) but Joe's eyes are a lighter brown and mine are a darker shade so it was still a mystery as to which set he got. Just like I hoped he would have Joe's eyelashes, I hoped he would have my color of brown. Well today I was holding him and he looked up at me and it was like looking into a mirror (only much better)! :-) We’re still not sure of the shape, though. . .currently, they don’t really look like either of ours.

Right now Logan is exercising. It is no wonder the doctors all thought he was more active than normal when I was pregnant—he kicks his legs non-stop. I think we have another soccer kicker in the family (my brother's position in high school and college). We definitely need to buy one of those toys that babies can kick and make music. He is moving all around the floor on a blanket right now.

I've continued to find out more about Logan's condition and although I'm still frustrated by what's on the internet (there's A LOT of jargon I have to swim through to end up with just a little information), it's starting to make more sense. (For all of my posts about Logan's brachial cleft fistula, click here.)

Basically, the branchial plates rupture to form gills in fish. In humans, these are supposed to be invaded by neighboring arches. Branchial clefts develop as a result of incomplete fusion of the cleft between the first and second branchial arches. Branchial pouches develop in the ear, tonsils, thymus, and parathyroid glands. (Therefore, these fistulas occur in the ear and/or neck.)

First branchial clefts are divided into type I and type II. Type I are located near the external auditory canal. (i.e. the ear--what some members of Joe's family have.) Type II are associated with the submandibular gland or found in the anterior triangle of the neck.

The second branchial accounts for 95% of branchial anomalies. Most frequently, second branchial clefts are identified along the anterior border of the upper third of the sternocleidomastoid muscle and adjacent to the muscle. However, these may present anywhere along the course of a second branchial fistula, which proceeds from the skin of the lateral neck, between the internal and external carotid arteries, and into the palatine tonsil or parathyroid mass.

Third branchial clefts are rare. A third branchial fistula extends from the same skin location as a second branchial fistula; however, a third branchial fistula courses posterior to the carotid arteries and pierces the thyrohyoid membrane to enter the larynx. Third branchial clefts occur anywhere along that course (inside the larynx), but they are characteristically located deep to the sternocleidomastoid muscle.

Fourth branchial cleft cysts are extremely rare. A fourth branchial fistula arises from the lateral neck and parallels the course of the recurrent laryngeal nerve (around the aorta on the left and around the subclavian artery on the right--area of the thymus).

Many branchial cleft cysts are asymptomatic. They may become tender, enlarged, or inflamed, or they may develop abscesses, especially during periods of upper respiratory tract infection, due to the lymphoid tissue located beneath the epithelium. Spontaneous rupture of an abscessed branchial cleft cyst may result in a purulent draining sinus to the skin or the pharynx.

Surgery is indicated for branchial anomalies because there is a lack of spontaneous regression, a high rate of recurrent infection, the possibility of other diagnoses, and malignant degeneration.

The treatment of choice is complete surgical excision of the cyst or sinus tract. If branchial fistulas, sinuses, or cysts are noted in the neonatal period, surgery can be postponed until three to six months of age. This allows the child to grow and hopefully precedes a first upper respiratory infection which may lead to infection. If the abnormality is noted after six months of age, surgery should be done as soon as possible. The reason for this early excision is the high incidence of secondary infections of these lesions - probably at least 25% before definitive surgery.

So we're not sure which type Logan has yet, but it sounds like they get more serious as the types increase. I'm sure we'll find out a week from today when we meet with the doctors. This may also explain why he gets congested every now and then. It's not as bad as it was when we first brought him home from the hospital, but since his condition is a sinus problem, maybe that was why his breathing is sometimes raspy after eating.

He also had a plugged tear duct last week. I didn't know what it was, but last Tuesday his right eye had lots of yellow gunk in it that I kept wiping away all day. I was worried he had an infection or something, but when I asked our pediatrician on Wednesday, he explained that is very normal with babies.

I've been doing more laundry than normal because Logan leaks non-stop through his diapers (laundry has become a daily thing since having a baby)! Like I said last time, it doesn't matter whether we use organic or non-organic (they both leak equally), so I might as well use organic and then I don't have to feel quite as guilty about not using cloth (which I'm too lazy to do since he poops so often and the mess is so extreme, and have heard cloth leaks the worst). Pampers we only tried in the very beginning (it's what they gave us at the hospital) but not since then because they are the only brand that caused diaper rash for Logan. Huggies didn't cause him any rash but I'm not comfortable with the chemicals against his genitalia every day for 2+ years. So, we're now just using 7th Generation, 365 (Whole Foods), and Earth's Best. . .until he's potty-trained which will be nice the day that happens!