Utility and safety of methylene blue demarcation of preauricular sinuses and branchial sinuses and fistulae in children

J Matthew Dickson, Keith H Riding, Jeffrey P Ludemann
Journal of Otolaryngology—Head & Neck Surgery 2009, 38 (2): 302-10

OBJECTIVE: To report our experience at British Columbia's Children's Hospital (BCCH) with the use of methylene blue (MB) to demarcate preauricular sinuses (PASs) and branchial sinuses and fistulae (BSF) in children under general anesthesia just prior to surgical excision.

METHODS: A retrospective chart review was performed of all cases at BCCH between March 2003 and April 2006 in which MB was used to demarcate PASs and BSF. A review of the literature regarding the utility and safety of topical MB was performed.

RESULTS: MB demarcation of 20 PASs enabled precise resection with the involved auricular cartilage and obviated the need for en bloc resection. In 11 BSF, MB differentiated between sinuses and fistulae, identified the branchial cleft involved, demonstrated (in two patients) a thin fistula that was not visible on high-resolution contrast-enhanced computed tomography, and enabled excision with the use of small incisions and minimal dissection. In our series, there have been no recurrences and no complications from the use of MB.

CONCLUSIONS: MB demarcation of PASs and BSF enables minimally invasive surgery and helps ensure complete resection. This is an extremely useful and relatively safe technique that has been underreported in the otolaryngology literature.

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