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Clinical appearance

The patient is usually a child or adolescent. The external opening of the sinus or fistula is usually surprisingly low on the neck, and is often over the anterior border of the sternomastoid muscle (Figure 107) just above the clavicle (collar bone). Internally, the tract cannot be identified by examination of the neck or throat, but it can, if necessary, be outlined by injecting a little dye into the opening of the cyst or fistula, which is usually quite distinctive. In terms of symptoms, apart from the presence of a punctum in the skin there is usually a slight, persistent discharge of mucus from the tract.