Int Arch Otorhinolaryngol 2015; 19(04): 309-313
DOI: 10.1055/s-0035-1556823
Original Research
Thieme Publicações Ltda Rio de Janeiro, Brazil

Open and Endoscopic Management of Fourth Branchial Pouch Sinus – Our Experience

Pavai Arunachalam
1  Department of Paediatric Surgery, PSG Institute of Medical Sciences & Research, Coimbatore, India
,
Venkatraman Vaidyanathan
2  Department of Otolaryngology and Head and Neck Surgery, PSG Institute of Medical Sciences & Research, Peelamedu, Coimbatore, India
,
Palaninathan Sengottan
2  Department of Otolaryngology and Head and Neck Surgery, PSG Institute of Medical Sciences & Research, Peelamedu, Coimbatore, India
› Author Affiliations
Further Information

Publication History

11 February 2015

17 May 2015

Publication Date:
13 July 2015 (eFirst)

  

Abstract

Introduction Acute suppurative neck infections associated with third or fourth branchial arch fistulas are frequently recurrent. Third and fourth branchial arch anomalies are much less common and usually present with recurrent left thyroid lobe abscesses.

Objectives The authors present their experience in treating such cases that were observed exclusively in children.

Methods The study involved performing a retrospective review of five cases in PSG Institute of Medical Sciences & Research. All cases were evaluated radiologically and with Direct Rigid hypopharyngoscopy. Definitive surgery was performed, including hemithyroidectomy.

Results The patients consisted of five children, two boys and three girls. All of them presented with recurrent episodes of neck infection. Investigations performed included computed tomography (CT) fistulography, rigid hypopharyngoscopy and ultrasound, which were useful in preoperatively delineating pyriform sinus fistulous tract. All patients underwent neck exploration with excision of the fistulous tract and hemithyroidectomy. Upon follow-up, all patients are asymptomatic.

Conclusions Recurrent neck abscesses in a child should alert the clinician to the possibility of a fourth branchial arch anomaly; therefore, children with this condition require a complete evaluation so the anomaly can be ruled out.