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Rowlands N, Russo C, Liu K, Yassall A, Chiang T, Ho ML. Clinical Characteristics of Branchial Cleft Anomalies. AJNR Am J Neuroradiol 2025; 46:815-819. [PMID: 40147832 PMCID: PMC11979844 DOI: 10.3174/ajnr.a8604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 10/09/2024] [Indexed: 03/29/2025]
Abstract
BACKGROUND AND PURPOSE Branchial cleft anomalies (BCA) are a group of relatively common congenital pediatric neck masses, which exhibit wide variability in clinical presentation and treatment approaches. This study attempts to fill this gap by evaluating BCA clinical, radiographic, and treatment features in a large cross-sectional cohort. MATERIALS AND METHODS We performed a retrospective cross-sectional study of patients with BCA presenting to a single pediatric quaternary care center between 2017 and 2023. The radiology information system was queried for the term "branchial," with diagnostic confirmation based on radiology and medical records review including patient demographics, clinical presentation and symptoms, genetic testing, interventions, and pathology. Relevant statistical tests were performed. RESULTS We retrospectively identified 302 unique patients with 412 imaging examinations that included the term "branchial" in the radiology information system between 2017 and 2023. The final cohort included 167 patients with a total of 246 imaging examinations. Among patients with BCA, median age at presentation was 3.3 years (range 0-22.9). Leading clinical presentations included a neck mass (88%, 147) and skin drainage (29%, 29). BCA classification was first in 37% (61), second in 44% (73), third in 4% (7), and fourth in 15% (26). Interventions included incision and drainage in 70% (121) and complete excision in 54% (91). Among patients with resected BCA, 22% (20/91) experienced at least 1 recurrence. CONCLUSIONS BCA have diverse clinical manifestations for which imaging aids in localization, classification, and interventional planning.
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Affiliation(s)
- Neil Rowlands
- From the Ohio University College of Osteopathic Medicine (N.R., A.Y.), Dublin, Ohio
| | | | - Kevin Liu
- University of Florida College of Medicine (K.L.), Jacksonville, Florida
| | - Anthony Yassall
- From the Ohio University College of Osteopathic Medicine (N.R., A.Y.), Dublin, Ohio
| | - Tendy Chiang
- Nationwide Children's Hospital (T.C.), Columbus, Ohio
| | - Mai-Lan Ho
- University of Missouri (M.-L.H.), Columbia, Missouri
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Sobotková K, Urík M, Perce K, Petrová B, Šikolová S, Bartoš M, Jančíková J, Kula R, Jabandžiev P. Fourth branchial cleft anomaly in a 7-month-old infant: A case report and literature review. EAR, NOSE & THROAT JOURNAL 2025; 104:NP191-NP194. [PMID: 35768198 DOI: 10.1177/01455613221106211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Fourth branchial cleft anomalies are rare head and neck congenital lesions seen in children. They present as a neck inflammatory mass and arise essentially on the left side of the neck. We report the case of a 7-month-old female with a mass of the neck associated with respiratory distress. The mass was diagnosed as an incomplete fourth branchial cleft fistula. Surgical revision of the neck abscess from an external approach and plasma coblation of the orifice in the pyriform fossa by an endoscopic approach were performed.
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Affiliation(s)
- Kateřina Sobotková
- Department of Paediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Milan Urík
- Department of Paediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Klára Perce
- Department of Paediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Barbora Petrová
- Department of Paediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Soňa Šikolová
- Department of Paediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Michal Bartoš
- Department of Paediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Jana Jančíková
- Department of Paediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Roman Kula
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Masaryk University Brno, Brno, Czech Republic
| | - Petr Jabandžiev
- Department of Pediatrics, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
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McMillan A, Chen S, Hua X. Management of a Piriform Sinus Fistula With Chronic Neck Infection in an Adult. Ann Otol Rhinol Laryngol 2024; 133:1029-1032. [PMID: 39302013 DOI: 10.1177/00034894241280693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2024]
Abstract
OBJECTIVES A pyriform sinus fistula (PSF) is a rare congenital anomaly due to failed obliteration of the third or fourth pharyngeal pouch. Diagnosis and management of PSF remains controversial. We present a case of PSF and discuss its diagnosis and management. METHODS Case report and literature review. RESULTS A 26-year-old female with a chronic left lateral neck abscess was diagnosed with a left PSF. She underwent surgery through a combined approach to close the openings of the PSF, internally and externally. We first placed a blunted ET tube into the internal opening of the PSF. We then performed an external transcervical approach to close the PSF at the cricothyroid membrane. Briefly, after a neck debridement and washout of the chronic neck infection, we identified the recurrent laryngeal nerve (RLN) in Lore's triangle. We performed left hemithyroidectomy to facilitate the dissection and protection of the RLN to its entrance into the larynx. A flexible laryngoscope was then inserted into the left piriform sinus through the ET tube to guide external dissection by transillumination. The scar tissue attached to the superior pole of the left thyroid lobe was then ligated and divided along the cricothyroid membrane. Lastly, we cauterized the internal opening of the PSF. The patient has remained recurrence-free for 1.5 years with normal vocal cord mobility. Histopathology revealed presence of a squamous-lined tract adjacent to the thyroid tissue. CONCLUSIONS Surgical treatment for patients with PSF should be aimed at closing the internal and external openings of the PSF, debriding chronic neck infection, and protecting the laryngeal nerves, instead of removing the entire tract. A concurrent hemithyroidectomy facilitates the identification and protection of the RLN, as well as excision of the tract. Differentiation between third and fourth branchial cleft fistulae may not be clinically necessary, as it is unlikely to alter the therapeutic plan.
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Affiliation(s)
- Alexandra McMillan
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Stephanie Chen
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Xiaoyang Hua
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Bee-See G, Anuar NA. Endoscopic diagnostic and therapeutic management of branchial cleft fistula type III & IV: a single tertiary centre experience. Eur Arch Otorhinolaryngol 2024; 281:6711-6715. [PMID: 39073435 DOI: 10.1007/s00405-024-08853-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 07/15/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION To date, recurrent neck abscesses associated with branchial anomalies are treated using a variety of techniques. Management strategies may include various imaging modalities and surgical methods. Endoscopic assessment and electrocauterization are the preferred diagnostic modalities and treatment strategies that have recently gained widespread acceptance and popularity. METHODOLOGY AND RESULTS This was a retrospective review on patients' medical record from 2016 to 2023. Seven patients underwent endoscopic cauterization at our centre, a tertiary academic institution. Five of the patients (71.5%) achieved complete remission. Two patients experienced recurrence within 6 months that necessitated re-cauterization once but subsequently recovered completely. Currently, endoscopic management is the preferred approach compared to the typical open neck excision surgery as it is significantly less invasive, resulting in lesser morbidity and similar success rates. At presentation, all of them had ultrasound neck that suggestive of neck abscess. Computed tomography or magnetic resonance imaging unable to provide adequate information about the side of internal opening of fistula where only 3 out of 7 patients demonstrated tract up to the ipsilateral region of pyriform fossa. DISCUSSION Management outcomes of this limited case series showed the potential benefits of endoscopic cauterization as the minimally invasive therapeutic method for recurrent neck abscesses caused by third and fourth branchial cleft fistulas but also to suggest the possibility as the first diagnostic tool prior to imaging studies.
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Affiliation(s)
- Goh Bee-See
- Department of Otorhinolaryngology, Head & Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, 56000 Cheras Wilayah Persekutuan, Kuala Lumpur, Malaysia.
- Hospital Canselor Tuanku Mukhriz, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur, Malaysia.
| | - Noor Azrin Anuar
- Department of Otorhinolaryngology, Head & Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, 56000 Cheras Wilayah Persekutuan, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Mukhriz, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur, Malaysia
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Ji T, Long T, Liu Y, Tai J, Zhang J, Li Y, Zhang X, Liu Z, Liu Q, Sun N, Wang S, Ni X. A Decade of Single-Center Experience in Children With Congenital Pyriform Sinus Fistula (CPSF). Laryngoscope 2024; 134:5193-5200. [PMID: 39082625 DOI: 10.1002/lary.31668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 06/18/2024] [Accepted: 07/15/2024] [Indexed: 11/15/2024]
Abstract
OBJECTIVES To investigate the efficacy and safety of carbon dioxide (CO2) laser cauterization in the treatment of pediatric congenital pyriform sinus fistula (CPSF), and to track and follow up the long-term outcome of the postoperative patients. METHODS This retrospective study was conducted at a single center, where clinical data and follow-up information of children with CPSF who underwent CO2 laser cauterization with the assistance of a suspension laryngoscope and microscope were collected and analyzed their clinical characteristics and prognosis. Subsequently, multiple logistic regression analysis was performed to identify potential predictors of the number of laser cauterization procedures. RESULTS A total of 238 children diagnosed with CPSF were recruited for this study, with 235 patients successfully achieving closure of the internal fistula through one or more CO2 laser cauterization procedures without recurrence. The median duration of follow-up was 6.46 (5.20, 7.64) years. Merely three patients (1.3%) developed recurrent cervical infection and eventually underwent open neck surgery. There were no instances of permanent perioperative complications throughout the follow-up. Additionally, our analysis revealed that the age at the first operation of CO2 laser cauterization was an independent risk factor associated with the number of operations. CONCLUSIONS The CO2 laser cauterization for children with CPSF is an effective and safe treatment with a low recurrence rate and minimal complications during the follow-up period. Consequently, it is advisable to consider CO2 laser cauterization as a viable therapeutic option for managing pediatric CPSF. LEVEL OF EVIDENCE 4 Laryngoscope, 134:5193-5200, 2024.
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Affiliation(s)
- Tingting Ji
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ting Long
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yuwei Liu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jun Tai
- Department of Otorhinolaryngology, Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Jie Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yanzhen Li
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xuexi Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhiyong Liu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Qiaoyin Liu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Nian Sun
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shengcai Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xin Ni
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Department of Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Li J, Zhang YJ, Wang QQ, Pang Q. An effective surgery to reduce the recurrence rate of pyriform sinus fistula: Importance of nurse cooperation. Asian J Surg 2024:S1015-9584(24)02671-X. [PMID: 39613647 DOI: 10.1016/j.asjsur.2024.11.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Revised: 10/24/2024] [Accepted: 11/05/2024] [Indexed: 12/01/2024] Open
Affiliation(s)
- Jie Li
- Department of the First Operating Room, Shandong Second Provincial General Hospital, Huaiyin District, Jinan City, Shandong Province, China.
| | - Yu-Ju Zhang
- Department of the First Operating Room, Shandong Second Provincial General Hospital, Huaiyin District, Jinan City, Shandong Province, China.
| | - Qi-Qi Wang
- Department of the First Operating Room, Shandong Second Provincial General Hospital, Huaiyin District, Jinan City, Shandong Province, China.
| | - Qi Pang
- Department of the First Operating Room, Shandong Second Provincial General Hospital, Huaiyin District, Jinan City, Shandong Province, China.
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Chen J, Wang Y, Shen C, Wang J, Li X. A novel and efficient surgical procedure for pyriform sinus fistulas in children. Front Pediatr 2024; 12:1297831. [PMID: 38884103 PMCID: PMC11178361 DOI: 10.3389/fped.2024.1297831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 05/13/2024] [Indexed: 06/18/2024] Open
Abstract
Objective This study aims to evaluate the efficacy of a novel surgical procedure for pyriform sinus fistulas in children via the external cervical approach through the hypopharynx. Methods A retrospective analysis was conducted on 71 pediatric patients with pyriform sinus fistula (PSF) who underwent treatment at the Department of Otolaryngology Head and Neck Surgery, Shanghai Children's Hospital, from 2012 July to 2022 July. Surgical treatment of PSF was performed via the external cervical approach through the hypopharynx, with dye instilled through the internal opening to serve as a guide for tract identification. Results All the internal orifices were found in the pyriform sinus by direct laryngoscopy in all 71 patients under general anesthesia. Two patients had a postoperative temporary hoarseness that resolved after 3 months. The other patients had no complications such as parapharyngeal abscess and incision infection. All patients were followed up for 23 months-70 months, and no recurrence was found. Conclusion The novel surgical procedure of PSF performed via the hypopharynx has advantages such as a short operation path, quick recovery, fewer complications, and a low recurrence rate. This method is a better choice for managing recurrence cases after repeated cauterization endoscopic surgeries, as well as for patients with visible cervical surgical scars or masses.
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Affiliation(s)
- Jiarui Chen
- Department of Otorhinolaryngology-Head & Neck Surgery, Shanghai Children's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ying Wang
- Department of Otorhinolaryngology-Head & Neck Surgery, Shanghai Children's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chenling Shen
- Department of Otorhinolaryngology-Head & Neck Surgery, Shanghai Children's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jing Wang
- Department of Otorhinolaryngology-Head & Neck Surgery, Shanghai Children's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaoyan Li
- Department of Otorhinolaryngology-Head & Neck Surgery, Shanghai Children's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Zhang S, Yuan Z, Xia Z, Chen H, Zhang Z, Chen M, Ye F. Clinical Features and Treatment of Congenital Pyriform Sinus Fistula: Analysis of 12 Cases. EAR, NOSE & THROAT JOURNAL 2024; 103:319-323. [PMID: 35968827 DOI: 10.1177/01455613221117004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Congenital pyriform sinus fistula (CPSF) is a rare congenital disease derived from the remnants of the third or fourth branchial cleft. OBJECTIVES To investigate the imaging characteristics, clinical manifestations, surgical methods, complications, and personalized treatment of CPSF. MATERIAL AND METHODS The clinical data of 12 CPSF patients admitted to the Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Wenzhou Medical University from March 2016 to May 2021 were retrospectively analyzed. Cryogenic plasma radiofrequency ablation, carbon dioxide laser resection, and external cervical excision were selected based on the individual condition, and postoperative complications and efficacy were evaluated. RESULTS There were 6 men and 6 women. Neck abscess or thyroiditis was considered at the initial diagnosis. In 11 of the cases, the CPSF was on the left side, whereas in the rest one case, it was on the right. A pyriform fossa fistula was observed during hypopharyngeal iodine angiography. Eight patients were treated with endoscopic piriform fossa fistula laser resection, two with cryogenic plasma radiofrequency ablation, and the rest with external cervical fistula resection. There was no evidence of postoperative hoarseness, pharyngeal fistula, dysphagia, and other complications. CONCLUSION AND SIGNIFICANCE CPSF is less common in adults than in children. For patients with recurrent neck abscesses, CPSF should be highly suspected, timely angiography should be performed as soon as possible, and care should be taken to avoid missed diagnoses. The primary method for piriform fossa fistula removal is surgical treatment. Finally, tailoring treatment regimens to the patient's condition can significantly improve curative efficacy.
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Affiliation(s)
- Shurou Zhang
- Department of Otorhinolaryngology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ziyi Yuan
- Department of Otorhinolaryngology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhigang Xia
- Department of Otorhinolaryngology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huanqi Chen
- Department of Otorhinolaryngology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ziheng Zhang
- Department of Otorhinolaryngology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Mengjiao Chen
- Department of Otorhinolaryngology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Fan Ye
- Department of Otorhinolaryngology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Katayama S, Oshio T, Ohtsu K, Sasaki K, Nakahara Y, Toyooka K, Hanaki S, Kawamoto K. Closure of the Entire Fistula With Highly Effective Chemocauterization Using the Distal Hood Endoscope: A Novel Procedure for the Treatment of Pyriform Sinus Fistula. Cureus 2024; 16:e59245. [PMID: 38813274 PMCID: PMC11134518 DOI: 10.7759/cureus.59245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Pyriform sinus fistula (PSF) causes a recurrent abscess in the neck. Endoscopic chemocauterization with trichloroacetic acid (TCA) for PSF is a simple, reproducible, and reliable procedure for treating PSF; however, there is concern about complications caused by TCA overflowing into the larynx. To prevent these complications, we devised a highly effective chemocauterization using a distal hooded endoscope (HuDHE). Our aim is to determine the efficacy and safety of HuDHE in children with PSF. METHODS The main features of HuDHE are as follows (1) an endoscope with a translucent silicon hood at the tip was made; (2) TCA was endoscopically injected into the PSF; and (3) the color change of the mucosa into PSF was endoscopically evaluated. Data on children receiving HuDHE for PSF in the past seven years were collected from medical records. RESULTS Data were obtained for eight children receiving HuDHE. The success rate of treatment for PSF after the first TCA chemocauterization was 87.5% (7/8) and the cumulative success rate after the second treatment was 100% (8/8). None of the children had recurrent PSF or serious complications such as vocal cord paralysis after HuDHE. CONCLUSION HuDHE appears to be a less invasive, safe, and effective treatment for PSF.
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Affiliation(s)
| | | | - Kazuhiro Ohtsu
- Pediatric Surgery, Hiroshima Prefectural Hospital, Hiroshima, JPN
| | - Kiyoshi Sasaki
- Pediatric Surgery, Kochi Health Sciences Center, Kochi, JPN
| | - Yasuo Nakahara
- Pediatric Surgery, National Hospital Organization Okayama Medical Center, Okayama, JPN
| | - Kosuke Toyooka
- Pediatric Surgery, Kurashiki Central Hospital, Kurashiki, JPN
| | - Shojiro Hanaki
- Pediatric Surgery, Kurashiki Central Hospital, Kurashiki, JPN
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Wang T, Roof S, Westra WH. Pulse granuloma presenting as a lateral neck mass: An unusual presentation of a fourth branchial cleft fistula. Head Neck 2023; 45:E49-E52. [PMID: 37646526 DOI: 10.1002/hed.27496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/01/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND The pulse granuloma (PG) is believed to represent a distinctive foreign body reaction to ingested particles of legumes. Its presentation in the neck is entirely unexpected. METHODS A woman presented with a mass of the lower neck that recurred following incision and drainage. The recurrent mass was found to be associated with an open sinus tract at the apex of the left pyriform sinus. The opening of the sinus tract was closed and the cyst was removed. RESULTS Histologic examination of the neck mass showed vegetable material with an associated granulomatous reaction known as PG. CONCLUSIONS The documentation of a PG arising in the neck would seemingly discredit the legume theory, but it only further supports it. Its association with a fourth branchial cleft cyst provides evidence for the existence of the complete fourth branchial cleft fistula with seeding of ingested material through sinus tract opening.
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Affiliation(s)
- Tiffany Wang
- The Department of Pathology, The Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Scott Roof
- The Department of Otolaryngology/Head and Neck Surgery, The Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - William H Westra
- The Department of Pathology, The Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
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11
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Zhang W, Glaun MDE, Carol Liu YC. Congenital Pyriform Fossa Lesions: Complex Management. Am Surg 2023; 89:1236-1238. [PMID: 33517705 DOI: 10.1177/0003134821989053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Wynne Zhang
- Baylor College of Medicine, Houston, TX, USA
| | - Mica D E Glaun
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Yi-Chun Carol Liu
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
- Division of Pediatric Otolaryngology, Texas Children's Hospital, Houston, TX, USA
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12
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Aristizabal MA. Fourth Branchial Cleft Cyst: An Important Differential Diagnosis in Lateral Neck Masses. Cureus 2023; 15:e36913. [PMID: 37139277 PMCID: PMC10151110 DOI: 10.7759/cureus.36913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
Branchial anomalies are a result of abnormal development during embryogenesis and are a rare cause of lateral neck masses of congenital origin. The second branchial cleft is the most common site of origin, with abnormalities arising from the first, third, and fourth clefts being rarer. Although cysts originating from branchial clefts are infrequent, it is important to consider this pathology in the differential diagnosis of neck masses, particularly those located laterally. This article discusses a rare case of a 49-year-old female patient who presented with the sudden appearance of a lateral neck mass after sports practice. The patient underwent extensive diagnostic studies, including radiological studies, which were compatible with a fourth branchial cleft cyst. The patient remains asymptomatic, and possible surgical treatment is being evaluated by the head and neck surgery service. This clinical case highlights the importance of prompt diagnosis and appropriate management of rare pathologies such as branchial cleft cysts.
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Fourth branchial cleft cyst in an infant. Case report and modified surgical approach. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2022.102445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Li Y, Yue H, Lei G, Wei F, Wang Z, Zhu X, Lei W. A safe and effective surgical method for complex pyriform sinus fistula. Laryngoscope Investig Otolaryngol 2022; 7:2145-2153. [PMID: 36544960 PMCID: PMC9764781 DOI: 10.1002/lio2.971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 11/18/2022] Open
Abstract
Objective This article aims to propose a new surgical method for the treatment of pyriform fistula, especially for the complex pyriform fistula. Methods A total of 36 patients with pyriform fistula underwent the procedure between August 2017 to October 2020. Surgery was performed by the senior authors using the same technique at the same clinical center for all patients. The median follow-up time was 33 months. Meantime, we collected information on patients with pyriform fistula using traditional surgical methods in our hospital from April 2015 to November 2018 for comparison. Results The surgery was successfully completed in 36 patients. In all, 32 patients had a history of multiple incisions and drainage, 16 patients had a history of surgical resections, and two patients had a history of cauterization of the internal fistula. Compared with traditional surgical methods, our new surgical method greatly shortens the length of the surgical incision (4.3 vs. 5.5, p < 0.0001), reduces the operation time (8.1 vs. 27.1, p < 0.0001), and reduces the blood loss (103.2 vs. 196.8, p < 0.0001). None of the 36 patients in this study had complications such as pharyngeal fistula, recurrent laryngeal nerve paralysis, or hypothyroidism. The mean follow-up duration after the excision of the lesion was 34.1 months. To date, no patients have relapsed. Conclusion Our experience showed that this surgical technique could be used to completely remove the fistula, and it was easier to perform than the conventional strategies. These treatment options result in less trauma and reliable results, especially for complex pyriform fistulas. Level of evidence IV.
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Affiliation(s)
- Yun Li
- Otorhinolaryngology HospitalThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouGuangdongPeople's Republic of China
| | - Huijun Yue
- Otorhinolaryngology HospitalThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouGuangdongPeople's Republic of China
| | - Guoqing Lei
- Otorhinolaryngology HospitalThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouGuangdongPeople's Republic of China
| | - Fanqin Wei
- Otorhinolaryngology HospitalThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouGuangdongPeople's Republic of China
| | - Zhangfeng Wang
- Otorhinolaryngology HospitalThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouGuangdongPeople's Republic of China
| | - Xiaolin Zhu
- Otorhinolaryngology HospitalThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouGuangdongPeople's Republic of China
| | - Wenbin Lei
- Otorhinolaryngology HospitalThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouGuangdongPeople's Republic of China
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15
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李 伟, 黄 正, 李 琦. [A preliminary study on low temperature plasma obliteration for pyriform sinus fistula by visual laryngoscope]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:51-54. [PMID: 34979620 PMCID: PMC10128214 DOI: 10.13201/j.issn.2096-7993.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Indexed: 06/14/2023]
Abstract
Objective:To investigate the effect of low-temperature plasma obliteration for pyriform sinus fistula by visual laryngoscope. Methods:The clinical data of 29 cases with congenital pyriform sinus fistula receiving low temperature plasma obliteration by visual laryngoscope during March 2019 to August 2021 was retrospectively analyzed in department of Otolaryngology Head and Neck Surgery of Children's Hospital of Nanjing Medical University. Nineteen cases accepted the pyriform sinus fistula probing + fistula obliteration, 6 cases accepted the pyriform sinus fistula probing + fistula obliteration + neck abscess incision and drainage, and 4 cases with cervical abscess accepted the pyriform sinus fistula probing + fistula obliteration. Results:All cases had no obvious complications. Two cases had vocal cord impairment after operations and recovered after one month. There was no recurrence in 2 to 30 months follow up, with mean 16 months follow up. Conclusion:Low-temperature plasma obliteration of pyriform sinus fistula by visual laryngoscope is a safe and effective surgical method with little trauma and short hospital stay. It could be the first choice for the treatment of pyriform sinus fistula. Incision and drainage of neck abscess and pyriform sinus fistula obliteration could be performed concurrently.
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Affiliation(s)
- 伟 李
- 南京医科大学附属儿童医院耳鼻咽喉头颈外科(南京，210008)Department of Otolaryngology Head and Neck Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - 正华 黄
- 南京医科大学附属儿童医院耳鼻咽喉头颈外科(南京，210008)Department of Otolaryngology Head and Neck Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - 琦 李
- 南京医科大学附属儿童医院耳鼻咽喉头颈外科(南京，210008)Department of Otolaryngology Head and Neck Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
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16
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Neonatal respiratory distress due to a third or fourth branchial pouch sinus: A systematic review. Int J Pediatr Otorhinolaryngol 2021; 151:110922. [PMID: 34525447 DOI: 10.1016/j.ijporl.2021.110922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/20/2021] [Accepted: 09/06/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Third and fourth branchial pouch sinuses can be rare causes of respiratory distress in neonates. An overview of this distinct clinical entity is missing in literature. To aid clinicians in recognizing and adequately treating this unique entity, we conducted a systematic review to discuss patient characteristics, diagnostic considerations and treatment strategy. METHODS MEDLINE and EMBASE were searched from inception to December 29th, 2020. Original studies concerning patients with respiratory symptoms as a result of a third or fourth branchial pouch sinus, as confirmed with rigid endoscopy, videofluoroscopy or during surgery. RESULTS Thirty-nine studies describing 56 patients (66% male, aged 0-30 days) were analyzed. Symptoms included cervical mass (76.8%), stridor (55.4%), dyspnea (35.7%) and cyanosis (17.9%) due to a third (39.3%) or fourth (60.7%) branchial pouch sinus. Intubation was performed before treatment in 31.3%. The piriform sinus opening was identified with rigid endoscopy in 81.1%. Surgery was the treatment of choice in the majority of patients (85.7%), with a success rate of 100% and a complication rate of 10.7%. Endoscopic cauterization was successful in 40% and endoscopic cauterization followed by sclerotherapy was successful 100%, with no complications. CONCLUSION Third or fourth branchial pouch sinuses can lead to respiratory distress in neonates. It is important to recognize this distinct clinical picture for adequate diagnosis and treatment. Rigid endoscopy is indicated to demonstrate an opening in the piriform sinus and provides the opportunity to directly perform treatment with endoscopic cauterization. If this is insufficient to relief respiratory symptoms due to a persistent cyst, sclerotherapy or surgical excision should be considered.
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17
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Boonen A, Hens G, Meulemans J, Hermans R, Delaere P, Vander Poorten V. Fourth Branchial Anomalies: Diagnosis, Treatment, and Long-Term Outcome. Front Surg 2021; 8:748351. [PMID: 34651012 PMCID: PMC8505890 DOI: 10.3389/fsurg.2021.748351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Fourth branchial anomalies, the rarest among anomalies of the branchial apparatus, often present diagnostic and therapeutic challenges. We evaluated the clinical presentation and radiographic features, the treatment and the long-term outcome of patients in this setting. Patients and Methods: Of 12 patients treated in the University Hospitals Leuven from 2004 until 2020, 12 variables were collected: date of birth, gender, age of onset of the symptoms, age at final diagnosis, presentation, laterality, previous procedures, diagnostic tools, treatment (open neck surgery, endoscopic laser excision, or combination), complications, recurrence, and period of follow-up. Descriptive statistics were calculated and results were compared to the existing literature. Results: The most common clinical manifestations were recurrent neck infections with and without abcedation. Definitive diagnosis using direct laryngoscopy, visualizing the internal sinus opening, was possible in all patients. A CT study revealed the typical features of fourth branchial anomalies in seven patients out of nine, an ultrasound study in five out of nine patients. All patients underwent open neck surgery. If this was insufficient, secondary endoscopic laser resection of the ostium at the apex of the piriform sinus was performed (n = 4). In eight patients a thyroid lobectomy was needed for safe complete resection. Postoperative complications were minimal and at long-term, none of the patients showed further recurrence. Average time of follow-up was 8.6 years. Conclusions: Direct laryngoscopy and CT are the most accurate diagnostic tools. Our recommended treatment schedule consists of complete excision of the sinus tract by open neck surgery as the primary treatment because this ensures the best results. In case of recurrence afterwards, endoscopic laser resection of the pharyngeal ostium solved the problem.
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Affiliation(s)
- Annelien Boonen
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Greet Hens
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jeroen Meulemans
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Robert Hermans
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Pierre Delaere
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
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18
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Dabaja E, Altinok D, O'Niel M, Sood BG. Neck Mass in a Full-term Infant with Hypoxic-Ischemic Encephalopathy. Neoreviews 2021; 22:e275-e278. [PMID: 33795405 DOI: 10.1542/neo.22-4-e275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - Mallory O'Niel
- Otolaryngology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI
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19
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Chen T, Chen J, Sheng Q, Zhu L, Bai X, Xu W, Liu J, Li X, Lv Z. Pyriform sinus fistula in children: A comparison of endoscopic-assisted surgery and endoscopic radiofrequency ablation. J Pediatr Surg 2021; 56:800-804. [PMID: 32709530 DOI: 10.1016/j.jpedsurg.2020.06.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/02/2020] [Accepted: 06/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pyriform sinus fistula (PSF) is a rare congenital anomaly, and the preferred definitive treatment is yet to be verified. In this study, we investigated the treatment outcomes of PSF specifically comparing endoscopic-assisted surgery and endoscopic radiofrequency ablation (RA). METHODS The medical records of patients treated for PSF at the Shanghai Children's Hospital between October 2016 and September 2019 were retrospectively evaluated. RESULTS There were 93 girls and 98 boys. The median age at onset and operation was 3 years and 5 years, respectively. Endoscopic-assisted surgery was performed in 143 patients. During the same period, RA was performed in 48 patients, and 10 of them concurrently underwent incision and drainage of neck abscesses. Longer hospital stay was found in the endoscopic-assisted surgery group than in the RA group (10.50 ± 3.93 vs. 5.02 ± 3.30 days, P < 0.001). Postoperative complications were not significantly different between the two groups, except for neck infection (0 vs. 8.3%, P = 0.004). After a median follow-up period of 21 months, no significant difference was found between the two groups in terms of recurrence (1.4% vs. 0, P = 0.560). CONCLUSION Patients treated with RA had a significantly shorter hospital stay than those treated with endoscopic-assisted surgery. Outcomes of endoscopic-assisted surgery and RA were not significantly different for the management of PSF and treatment method should be tailored to the patient. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Tong Chen
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200040, PR China
| | - Jianglong Chen
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200040, PR China
| | - Qingfeng Sheng
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200040, PR China
| | - Linlin Zhu
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200040, PR China
| | - Xiaoling Bai
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200040, PR China
| | - Weijue Xu
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200040, PR China
| | - Jiangbin Liu
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200040, PR China
| | - Xiaoyan Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200040, PR China.
| | - Zhibao Lv
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200040, PR China.
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20
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Li WX, Dong Y, Zhang A, Tian J, Lu C, Jeannon JP, Liu L. Surgical treatment of fourth branchial apparatus anomalies: a case series study. J Otolaryngol Head Neck Surg 2020; 49:79. [PMID: 33198806 PMCID: PMC7670670 DOI: 10.1186/s40463-020-00477-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/02/2020] [Indexed: 11/17/2022] Open
Abstract
Background Fourth branchial apparatus anomalies, are rare clinical entities, and present as complex cysts, sinuses and fistulae in the neck that can be difficult to manage. Methods This is a retrospective review of a series of consecutive patients with fourth branchial apparatus anomalies treated at Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, from Apr 2014 to Nov 2019. Results Ten patients with fourth branchial apparatus anomalies were identified, including 8 patients with fourth branchial fistula, and 2 patients with fourth branchial pouch sinus. There were 6 female patients and 4 male patients. Their age was from 6 years old to 39 years old (average age 20.4 years old, median age was 21 years old). All 8 fistulae were on the left side, while 2 pouch sinuses were both on the right side. Pre-operative examination with fiberoptic laryngoscope, barium swallow X-ray, CT or MRI identified internal orifice at pyriform fossa apex in 8 (80%) patients. All patients underwent challenging surgical resection by the senior author. Intra-operative direct laryngoscope confirmed or identified internal orifice in 9 (90%) patients. The tracts were all followed to the vicinity of inferior cornu of the thyroid cartilage and the cricothyroid space. Complete resection of cervical lesions and their attachment to hypopharynx were achieved in 9 cases. No complication occurred. One recurrence was detected, in the only patient whose internal orifice could not be located pre- or intra-operatively, and the hypopharyngeal attachment could not be removed. Conclusions Direct laryngoscopy under general anesthesia is a reliable method of diagnosis for the fourth branchial apparatus anomalies. Complete surgical removal of fourth branchial apparatus anomalies, including their hypopharyngeal attachment, is the treatment of choice, and the key to prevent recurrence.
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Affiliation(s)
- Wan-Xin Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, 95th Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Yanbo Dong
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, 95th Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Aobo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, 95th Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Jun Tian
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, 95th Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Cheng Lu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, 95th Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Jean Pierre Jeannon
- Surgical Oncology, Guy's & St Thomas NHS Hospital, Kings College London, London, UK
| | - Liangfa Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, 95th Yong'an Road, Xicheng District, Beijing, 100050, China.
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21
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Maksimoski M, Maurrasse SE, Purkey M, Maddalozzo J. Combination Surgical Procedure for Fourth Branchial Anomalies: Operative Technique and Outcomes. Ann Otol Rhinol Laryngol 2020; 130:738-744. [PMID: 33158383 DOI: 10.1177/0003489420971674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Branchial apparatus anomalies of the fourth cleft are the rarest subtype of anomaly and occasionally present with suppurative thyroiditis or thyroid abscess due to their relationship with the thyroid gland. Surgical approaches vary and some surgeons favor cauterization of associated pyriform sinus tracts alone versus complete surgical excision. Currently, the literature is scarce and there is limited data on surgical outcomes and procedural steps. Here we describe a combination surgical technique for fourth branchial anomalies including: (1) surgical excision of the cyst and any external pit, (2) hemithyroidectomy, and (3) direct laryngoscopy with cauterization of pyriform apex tract, if present. METHODS A retrospective review was performed on all patients who underwent surgical excision of fourth branchial apparatus lesions (including fistulae, cysts, and sinus tracts) at an urban pediatric university hospital from 2000 to 2019. Data regarding demographics, medical history, surgical methods, complications, and surgical cure rates were collected. RESULTS A total of 16 patients (9 female, 7 male) underwent a combination surgical procedure for fourth branchial apparatus lesions. Success rate after primary surgery was 94%. One patient had residual disease requiring re-operation. Two patients had post-operative complications: 1 transient vocal fold paresis and 1 seroma, both managed conservatively. A consensus surgical algorithm was created based on operative steps present in the majority of cases. CONCLUSION A combination approach to fourth branchial apparatus lesions-including endoscopic cauterization, external excision, and hemithyroidectomy-is safe and provides a high rate of primary cure. Although less invasive options exist, remnants of the branchial lesion, especially in the thyroid, may remain and cause recurrent issues. Therefore, we advocate for complete surgical excision of this rare developmental anomaly, especially when obvious thyroid involvement exists.
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Affiliation(s)
- Matthew Maksimoski
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sarah E Maurrasse
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Matthew Purkey
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John Maddalozzo
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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22
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Fockens MM, de Bakker BS, van Lienden KP, Dikkers FG, Hoekstra CEL. Endoscopic Cauterization and Sclerotherapy for Airway Obstruction by a Third Branchial Pouch Sinus. Laryngoscope 2020; 131:E1730-E1732. [PMID: 32915997 PMCID: PMC8246521 DOI: 10.1002/lary.29101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/14/2020] [Accepted: 08/26/2020] [Indexed: 11/10/2022]
Affiliation(s)
- M Matthijs Fockens
- Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bernadette S de Bakker
- Department of Medical Biology, Section Clinical Anatomy & Embryology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Krijn P van Lienden
- Department of Radiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Frederik G Dikkers
- Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Carlijn E L Hoekstra
- Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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23
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Han Z, Tai J, Gao J, Wang S, Yu T, Peng Y, Ni X. MRI in Children With Pyriform Sinus Fistula. J Magn Reson Imaging 2020; 53:85-95. [PMID: 32896061 DOI: 10.1002/jmri.27325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A variety of imaging modalities have been described for the diagnosis of congenital pyriform sinus fistula (CPSF). To date, there have been few MRI reports. PURPOSE To evaluate MRI findings of CPSF and interobserver reliability. STUDY TYPE Retrospective. POPULATION In all, 115 patients aged 23 days to 15.4 years at operation. FIELD STRENGTH/SEQUENCE 3.0T/axial T1 -weighted image (T1 WI)-SPIR, axial T2 WI, axial T2 WI-STIR, coronal T2 WI-SPIR, diffusion-weighted imaging (DWI), axial and coronal gadolinium-enhanced T1 WI-SPIR. ASSESSMENT For each patient, the medical records, including demographics, clinical manifestations, and MRI findings were reviewed. All the MRI studies were interpreted by three radiologists independently. STATISTICAL TEST Kendall's W test was made to determine the interobserver reliability of three reviewers for MRI findings. RESULTS CPSF occurred on the left side in 104 (90.4%) patients and on the right side in 11 (9.6%) patients. The male-to-female ratio was 59:56. The age at first episode varied from birth to 12.3 years. There was one neonate patient, who presented with a unilocular cystic mass in the left neck. A tunnel-like lesion between the pyriform fossa and the upper pole of the thyroid gland, T2 high signal behind the cricothyroid joint, thyroid gland involvement, deep neck abscesses or masses were noted in 46 (40%), 93 (80.9%), 96 (83.5%), and 36 (31.3%) patients, respectively. There was excellent interobserver reliability for all the MRI findings, ranging from 0.84 to 1.00. DATA CONCLUSION The sinus tract presenting with a tunnel-like lesion goes behind the cricothyroid joint in most cases. For patients presenting with acute suppurative thyroiditis (AST) or neck infection with thyroid gland involvement, the presence of T2 high signal behind the cricothyroid joint highly suggests the diagnosis of CPSF. MRI is a reliable method for the diagnosis of CPSF. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Zhonglong Han
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for children's Health, Beijing, China
| | - Jun Tai
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for children's Health, Beijing, China
| | - Jun Gao
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for children's Health, Beijing, China
| | - Shengcai Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for children's Health, Beijing, China
| | - Tong Yu
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for children's Health, Beijing, China
| | - Yun Peng
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for children's Health, Beijing, China
| | - Xin Ni
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for children's Health, Beijing, China
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Martinez-Monedero R, Danielian A, Angajala V, Dinalo JE, Kezirian EJ. Methodological Quality of Systematic Reviews and Meta-analyses Published in High-Impact Otolaryngology Journals. Otolaryngol Head Neck Surg 2020; 163:892-905. [PMID: 32450783 DOI: 10.1177/0194599820924621] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess the methodological quality of intervention-focused systematic reviews (SRs) and meta-analyses (MAs) published in high-impact otolaryngology journals. DATA SOURCES Ovid Medline, Embase, and Cochrane Library. REVIEW METHODS A comprehensive search was performed for SR and MA citations from 2012 to 2017 in the 10 highest impact factor otolaryngology journals. Abstracts were screened to identify published manuscripts in which the authors indicated clearly that they were performing an SR or MA. Applying a modified typology of reviews, 4 reviewers characterized the review type as SR, MA, or another review type. A simplified version of the AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews 2) tool was used to assess the reporting and methodological quality of the SRs and MAs that were focused on interventions. RESULTS Search and abstract screening generated 499 manuscripts that identified themselves as performing an SR or MA. A substantial number (85/499, 17%) were review types other than SRs or MAs, including 34 (7%) that were literature reviews. In total, 236 SRs and MAs focused on interventions. Over 50% of these SRs and MAs had weaknesses in at least 3 of the 16 items in the AMSTAR 2, and over 40% had weaknesses in at least 2 of the 7 critical domains. Ninety-nine percent of SRs and MAs provided critically low confidence in the results of the reviews. CONCLUSION Intervention-focused SRs and MAs published in high-impact otolaryngology journals have important methodological limitations that diminish confidence in the results of these reviews.
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Affiliation(s)
- Rodrigo Martinez-Monedero
- USC Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of USC, California, USA
| | - Arman Danielian
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Varun Angajala
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Jennifer E Dinalo
- Health Sciences Libraries, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Eric J Kezirian
- USC Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of USC, California, USA
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Ning Y, Li C, Wang X, Zhu G, Cai Y, Jang J, Sun R, Liu D, Sheng J. Resection of Second, Third, and Fourth Branchial Cleft Anomalies with Recurrent or Repeated Neck Infection Using the Selective Neck Dissection Technique. ORL J Otorhinolaryngol Relat Spec 2020; 82:59-66. [PMID: 32092758 DOI: 10.1159/000501893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/04/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To explore the applied value of the selective neck dissection to treat second, third, and fourth branchial cleft anomalies with recurrent or repeated neck infections. METHOD We made a retrospective study about 29 patients with the second, third, and fourth branchial cleft anomalies with recurrent or repeated neck infections who were treated by surgery from 2002 to 2018 in Sichuan Province Cancer Hospital. According to the characteristics of branchial cleft anomaly on embryology and anatomy, different types of selective neck dissection were chosen to remove pathological scar tissue or inflammatory tissue en bloc. RESULT Of 29 cases, 28 had primary healing, and 1 had local infection, healing after dressing change for a long time. In 1 case, branchial cleft anomalies adhered to the internal jugular vein, which was ruptured and sutured. During the follow-up time of 12∼195 months with an average of 91.76 months, there were no recurrent cases. CONCLUSION The selective neck dissection technique is safe and effective in the treatment of branchial cleft anomalies with recurrent or repeated neck infection.
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Affiliation(s)
- Yudong Ning
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Chao Li
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China,
| | - Xu Wang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.,Chengdu Medical College, Chengdu, China
| | - Guiquan Zhu
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yongcong Cai
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jian Jang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ronghao Sun
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Dinrong Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Neijiang Second People's Hospital, Neijiang, China
| | - JianFeng Sheng
- Department of Otorhinolaryngology Head and Neck Surgery, Mianyang Third People's Hospital, Mianyang, China
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Pu S, Li W, Xu H, Zhao L, Liu X, Li X. Open Surgical Excision Versus Endoscopic Radiofrequency Ablation for Piriform Fossa Fistula. EAR, NOSE & THROAT JOURNAL 2020; 100:700S-706S. [PMID: 32070124 DOI: 10.1177/0145561319898941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The purpose of this study is to explore the curative effect of open surgical excision and endoscopic radiofrequency ablation (RA) in the treatment of piriform fossa fistula (PSF). METHODS Retrospective study of 80 cases of PSF in the Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, from June 2009 to June 2017. RESULTS In this series, there were 43 males and 37 females, and the mean age was 5.2 years (17 days to 12 years). Surgical excision was performed for 62 patients. Radiofrequency ablation was performed for 18 patients. Six cases of postoperative temporary hoarseness occurred, and the hoarseness rates were not significantly different between the excision and RA groups (6.4% vs 11.1%, respectively, P = .88). Two cases of temporary neck abscess occurred in the RA group. After the mean follow-up period of 3.1 years (1-8 years), no recurrence was found between the excision and RA groups. CONCLUSIONS The curative effect of excision and RA for PSF is not significantly different; each of the 2 methods has its advantages and disadvantages. However, RA for PSF has the merit of being minimally invasive, easy to operate, and safe; this procedure seems to be more suitable in the clinic.
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Affiliation(s)
- Shilei Pu
- Department of Otolaryngology-Head and Neck Surgery, 36777Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Wanpeng Li
- Department of Otolaryngology-Head and Neck Surgery, 36777Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Department of Otorhinolaryngology, EYE and ENT Hospital of Fudan University, Shanghai, People's Republic of China
| | - Hongming Xu
- Department of Otolaryngology-Head and Neck Surgery, 36777Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Liming Zhao
- Department of Otolaryngology-Head and Neck Surgery, 36777Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Xiaojun Liu
- Department of Otolaryngology-Head and Neck Surgery, 36777Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Xiaoyan Li
- Department of Otolaryngology-Head and Neck Surgery, 36777Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Ding XQ, Zhu X, Li L, Feng X, Huang ZC. Resection of recurrent third branchial cleft fistulas assisted by flexible pharyngotomy. World J Clin Cases 2019; 7:3957-3963. [PMID: 31832397 PMCID: PMC6906575 DOI: 10.12998/wjcc.v7.i23.3957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/29/2019] [Accepted: 11/15/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Treatment of fistulas arising from the third branchial cleft includes endoscopic cauterization or open cervical fistulectomy. Both approaches are associated with recurrence rates of 14%-18%, and possibly greater rates when the fistula has been treated operatively beforehand. Treatment of fistulas arising from the third branchial cleft is associated with an inordinate recurrence rate. Recurrence may be multifactorial and related to incomplete resection of all of the anatomical elements of the fistula.
AIM To present a new approach that involves complete resection of the recurrent fistula by a combined therapeutic approach.
METHODS Here, 12 adult patients diagnosed with recurrent third branchial cleft fistulas underwent a combined therapy assisted by flexible fiber-optic pharyngoscopy to identify and resect the entry site of the fistula into the pyriform sinus. The fistulous opening into the pyriform sinus was identified by flexible fiber-optic pharyngoscopy. The application of intubation with a guidewire by pharyngoscopy, in addition to the removal of the partial excision of the thyroid cartilage, allowed complete resection of the opening and all parts of the fistula tract.
RESULTS All of the internal openings of the fistulas in the pharynx were found and easily identified by flexible fiber-optic pharyngoscopy. All of the 12 patients underwent complete resection of the recurrent fistula by the combined therapeutic approach. There were no postoperative complications such as parapharyngeal abscess or wound infection, injury or dysfunction of the recurrent laryngeal or superior laryngeal nerves. The pharyngeal edema had degraded, and the pharyngeal wound healed postoperatively within 1 wk. Laryngeal endoscopy and voice analysis were performed on the 14th d post-operatively. Vocal cord movements did not change. The characters of voice for jitter, shimmer, and normalized noise energy were all within normal limits. In addition, no recurrences were observed during the 13-60 mo follow-up period.
CONCLUSION It can be concluded that the proposed combined therapy is associated with excellent results, minimal morbidity, and no recurrence.
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Affiliation(s)
- Xiao-Qiong Ding
- Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital Southeast University, Nanjing 210000, Jiangsu Province, China
| | - Xin Zhu
- Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital Southeast University, Nanjing 210000, Jiangsu Province, China
| | - Ling Li
- Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital Southeast University, Nanjing 210000, Jiangsu Province, China
| | - Xu Feng
- Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital Southeast University, Nanjing 210000, Jiangsu Province, China
| | - Zhi-Chun Huang
- Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital Southeast University, Nanjing 210000, Jiangsu Province, China
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Li Y, Lyu K, Wen Y, Xu Y, Wei F, Tang H, Chen S, Wang Z, Zhu X, Wen W, Lei W. Third or fourth branchial pouch sinus lesions: a case series and management algorithm. J Otolaryngol Head Neck Surg 2019; 48:61. [PMID: 31711544 PMCID: PMC6849311 DOI: 10.1186/s40463-019-0371-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 09/09/2019] [Indexed: 01/06/2023] Open
Abstract
Background The purpose of this study was to develop an effective management algorithm for lesions of third or fourth branchial sinuses. Study design Case series with chart review. Methods Data from patients who were identified as having third or fourth branchial pouch sinus lesions in a single institution between January 2014 and December 2018 were retrospectively collected. Results All 67 patients underwent fistulectomy. First, we classified the patients into five types based on their anatomic features. Then, we considered four optimized surgical methods and adopted the appropriate method with full consideration of the patient’s clinical characteristics. The great majority of cases occurred on the left side of the neck (68.7%) and most commonly presented as either a recurrent low-neck abscess or cutaneous discharging fistula with neck infection. Effective preoperative examination included administering contrast agent prior to a computed tomography (CT) scan and in-office laryngoscopy during the quiescent period of inflammation. Ultrasound was also very helpful in determining the presence of thyroiditis. The mean follow-up duration after excision of the lesion was 25.8 months. To date, only 1 (1.5%) recurrence and no obvious complications have been observed. Conclusion Refining fistula subtypes and adopting corresponding treatment measures can reduce the recurrence rate and improve curative effects. We propose and advocate this treatment algorithm for all third and fourth branchial pouch lesions.
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Affiliation(s)
- Yun Li
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kexing Lyu
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yihui Wen
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yang Xu
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Fanqin Wei
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haocheng Tang
- Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Siyu Chen
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhangfeng Wang
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaolin Zhu
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Weiping Wen
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wenbin Lei
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Teng Y, Huang S, Chen G, Xian Z, Han S, Li L. Congenital pyriform sinus fistula presenting as a neck abscess in a newborn: A case report. Medicine (Baltimore) 2019; 98:e17784. [PMID: 31689849 PMCID: PMC6946197 DOI: 10.1097/md.0000000000017784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 09/17/2019] [Accepted: 10/03/2019] [Indexed: 12/02/2022] Open
Abstract
RATIONALE Congenital pyriform sinus fistula (CPSF) is a branchial abnormality originating from the third or fourth branchial pouch and is an important cause of anterior cervical abscess in children. Here we present a case of neck abscess in a newborn that was diagnosed as CPSF. PATIENT CONCERNS A male infant with a birth weight of 3660 g was admitted to hospital 25 minutes after birth after discovery of a cystic mass with extensive skin swelling in the left side of the neck. B-mode ultrasonography of the left neck showed an anterior cervical cystic mass of indeterminate nature. DIAGNOSIS Congenital pyriform sinus fistula. INTERVENTIONS The neck abscess was incised and drained under general anesthesia. Examination under suspension laryngoscopy revealed a pyriform sinus fistula. Laser cauterization was performed simultaneously. The wound was dressed and anti-inflammatory treatment was provided. OUTCOMES The neck wound healed uneventfully. After 3 months, the fistula was confirmed to be closed by laryngoscopy under general anesthesia. No recurrence was detected during 9 months of follow-up. LESSONS CPSF should be strongly suspected in a patient with an unexplained neck abscess or recurrent acute suppurative thyroiditis, especially on the left side.
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30
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Adnan SH, Nobecourt P, Tran S, Radhakrishnan RS, Bowen-Jallow KA. Fourth branchial cleft cyst and congenital absence of the contralateral thyroid lobe. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Rossi ME, Moreddu E, Leboulanger N, Akkari M, Triglia JM, Mondain M, Nicollas R, Denoyelle F. Fourth branchial anomalies: Predictive factors of therapeutic success. J Pediatr Surg 2019; 54:1702-1707. [PMID: 30981424 DOI: 10.1016/j.jpedsurg.2019.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of this work was to determine the epidemiology and the predictive factors of success of the surgical management of fourth branchial anomalies. METHODS This is a multicentric retrospective review from 1998 to 2016 of patients who presented with an endoscopically-confirmed fourth branchial pouch anomaly. Data were analyzed according to sex, age, clinical features, number of recurrences, treatment modalities (endoscopic and/or cervicotomy), post-operative complications and follow-up. RESULTS Fifty-two children have been included. The average age at diagnosis was 4.5 years. Among them, 73.1% were female, 11.4% were neonatal forms; 94.2% of lesions were left-sided; 75% of patients presented a cervical abscess as first symptom, and 7.7% of children presented with dyspnea. Average time between first symptoms and management was 9.5 months. Management was endoscopic in 73.1% of patients (laser in 84.2%, coagulation in 15.8%) with about a third of recurrence after one procedure. Overall success of endoscopic procedures reached 84.2%. A cervical open surgery was performed in 26.9% as first line treatment. Overall success of cervicotomy reached 85.7%. No complications of endoscopic surgery have been identified. There were 35.7% complications of cervicotomy (2 recurrent nerve palsy, 2 keloid scars, 1 pharyngostoma). An association was proved between recurrences and initial abscess (OR = 2.44), and with age between 3 and 5 (OR = 4). CONCLUSION Endoscopic treatments appear to be effective in first line approach in the management of fourth branchial anomalies, offering an excellent efficiency with rare complications. We identified two risk factors of recurrence: age between 3 and 5 years old and history of cervical abscesses. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Marie-Eva Rossi
- ENT department, Hôpital d'enfants La Timone, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France.
| | - Eric Moreddu
- ENT department, Hôpital d'enfants La Timone, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - Nicolas Leboulanger
- ENT department, Hôpital d'enfants Necker, Assistance Publique - Hôpitaux de Paris, Paris V Université, Marseille, France
| | - Mohamed Akkari
- ENT department, Hôpital Gui de Chauliac, Assistance Publique - Hôpitaux de Montpellier, Montpellier Université, Montpellier, France
| | - Jean-Michel Triglia
- ENT department, Hôpital d'enfants La Timone, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - Michel Mondain
- ENT department, Hôpital Gui de Chauliac, Assistance Publique - Hôpitaux de Montpellier, Montpellier Université, Montpellier, France
| | - Richard Nicollas
- ENT department, Hôpital d'enfants La Timone, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - Françoise Denoyelle
- ENT department, Hôpital d'enfants Necker, Assistance Publique - Hôpitaux de Paris, Paris V Université, Marseille, France
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Right-Sided Complete Third Branchial Cleft Fistula. J Craniofac Surg 2019; 30:e169-e170. [PMID: 30653037 DOI: 10.1097/scs.0000000000005115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Branchial cleft anomalies occur due to insufficient closure of cavities during embryogenesis. These anomalies consist of cysts, sinuses, and fistulas, with the rarest type being fistulas. A 29-year-old male presented at the authors' clinic with a right-sided complete third branchial cleft fistula. Fistula track excision surgery was successfully performed and no recurrence was observed in the 12-month follow-up after the surgery. While second branchial cleft fistula is the most common, third and fourth brancial cleft fistulas are extremely rare. In addition, they are usually incomplete and almost always on the left side.
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A unique location of branchial cleft cyst: case report and review of the literature. Int J Oral Maxillofac Surg 2018; 48:712-715. [PMID: 30579743 DOI: 10.1016/j.ijom.2018.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/11/2018] [Accepted: 11/30/2018] [Indexed: 11/21/2022]
Abstract
Branchial cleft cysts (BCC) are benign lesions caused by anomalous development of the branchial apparatus. This case report describes a 63-year-old woman with a 12 cm×12cm sized cystic mass located anterior to the manubrium sternum and sternum. MRI revealed a cystic lesion with a sinus tracking to the piriform sinus. Postoperative histopathological examination confirmed the diagnosis of branchial cleft cyst. Because of the course of the sinus track, it is believed that this was a fourth branchial cleft cyst. These are the rarest of the branchial anomalies, and extension below the peri-thyroid region is very infrequently described. When this extension occurs, it is always post-sternal into the mediastinum, and the pre-sternal presentation here appears to be unique. A review of the relevant literature was performed to summarize the clinical features of fourth branchial cleft cyst and to identify the best options for diagnosis and treatment.
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A Case of Pyriform Sinus Fistula with Respiratory Distress in the Neonatal Period. Case Rep Otolaryngol 2018; 2018:1696875. [PMID: 30034901 PMCID: PMC6033246 DOI: 10.1155/2018/1696875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/03/2018] [Indexed: 11/18/2022] Open
Abstract
Pyriform sinus fistula (PSF) is an anomaly that can arise due to failure of involution of the third or fourth branchial cleft during embryogenesis. It can manifest clinically as sinuses, cysts, or abscesses in the neck and is common in childhood. Herein, we describe a neonate who presented with neck swelling and respiratory distress, which was secondary to a fourth branchial pouch sinus. Physical examination revealed swollen areas in the posterolateral pharyngeal wall and on the external left side of the neck. Computed tomography imaging showed a left-sided mass that was filled with air and fluid. Eventually, the pyriform sinus cyst and the entire fistulous tract were excised. The postoperative course was uneventful. Follow-up after 18 months showed no recurrence.
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Li W, Xu H, Zhao L, Li X. Branchial anomalies in children: A report of 105 surgical cases. Int J Pediatr Otorhinolaryngol 2018; 104:14-18. [PMID: 29287855 DOI: 10.1016/j.ijporl.2017.10.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 10/22/2017] [Accepted: 10/23/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Branchial anomalies (BAs) account for 20% of all congenital masses in children. We sought to review the incidence of involvement of individual anomalies, diagnostic methods, surgical treatment, and complications of BAs in children. In addition, we also classified our study and analyzed a congenital lower neck cutaneous fistula near the sternoclavicular joint that was thought to be the skin-side remnant of the fourth BAs. METHODS We conducted a retrospective analysis of 105 children who were referred to our hospital from June 2009 to December 2016 for the treatment of BAs. RESULTS In this series, there were 51 males and 54 females. The age at the time of operation varied from 19 days to 13 years, and the mean age was 4.5 years. A total of 33 (31.4%) cases presented with first BAs, 13 (12.4%) presented with second BAs, and 59 (56.2%) presented with third and fourth BAs, including 6 cases of congenital lower neck cutaneous fistula. Fistulectomy under general anesthesia was performed on all of them. For postoperative complications, 2 cases had temporary facial paralysis, 1 case had permanent facial paralysis, 4 cases had temporary recurrent laryngeal nerve injury. Recurrence occurred in 2 patients with first BAs after medium follow-up time of 3.6 years (6 months-8 years). CONCLUSIONS BAs are common congenital head and neck lesions in children, and there are four distinct types (first, second, third and fourth anomalies). The incidence of third and fourth BAs in Asia maybe higher when compared with literature reports, second BAs seem rare in this population, but more research is needed to confirm this perspective. Diagnosis is not difficult with a proper knowledge of the anatomy of the BAs. The surgical procedures should be tailored depending on the various types, and complete excision of the fistula is the key to prevent recurrence.
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Affiliation(s)
- Wanpeng Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Hongming Xu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Liming Zhao
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Xiaoyan Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China.
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Endoscopic electrocauterization of pyriform sinus fistula. Eur Arch Otorhinolaryngol 2017; 274:3927-3931. [PMID: 28836049 DOI: 10.1007/s00405-017-4713-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 08/10/2017] [Indexed: 12/16/2022]
Abstract
To determine the efficacy of endoscopic electrocauterization for pyriform sinus fistula (PSF) using a flexible Bugbee cautery electrode. From 2009 to 2016, a total of eight patients with acute suppurative thyroiditis or cervical abscess secondary to PSF were retrospectively registered in our study (three males, five females; median age 6.5 years). All patients underwent endoscopic electrocauterization as treatment for PSF. Six of eight patients had no recurrence after the initial endoscopic electrocauterization of PSF. One patient with recurrence developed symptoms 9 days after cauterization and another experienced recurrence after 2 years. Mean follow-up for the eight patients was 50 months (range 5-96 months). No post-operative complication was reported. Endoscopic electrocauterization appears to be a less-invasive, safe, and effective method for the treatment of PSF.
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Endoscopic electrocautery and fibrin obliteration of an acutely complicated pyriform fossa sinus tract in a septuagenarian. The Journal of Laryngology & Otology 2017. [DOI: 10.1017/s0022215117001177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AbstractBackground:Pyriform fossa sinus tracts classically present with neck abscess, recurrent infections and suppurative thyroiditis in children; acute presentation in a geriatric patient is rare.Methods:Case report and Medline literature review.Case report:A 79-year-old female presented with a left-sided neck mass and severe odynophagia of 3 days’ duration. Magnetic resonance imaging revealed a large-volume, loculated fluid collection extending throughout the deep spaces of the neck on the left, within and around the thyroid gland capsule. There was radiological evidence of internal jugular vein thrombophlebitis. Abscess incision and drainage, and endoscopic evaluation, were performed. A deeply penetrating sinus was seen in the left pyriform apex, the entrance of which was circumferentially cauterised and the lumen obliterated with fibrin glue. Following post-operative intravenous antibiotics, the patient made a complete recovery.Conclusion:This paper describes the first use of fibrin glue to obliterate a pyriform fossa sinus tract in an adult.
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Narasimhan V, Grodski S. Rare finding of a fourth branchial cleft anomaly. ANZ J Surg 2017; 88:E853-E854. [PMID: 28337835 DOI: 10.1111/ans.13947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/24/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Vignesh Narasimhan
- General Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Simon Grodski
- General Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia.,Endocrine Surgery Unit, Monash University, Melbourne, Victoria, Australia
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Di Nardo G, Valentini V, Angeletti D, Frediani S, Iannella G, Cozzi D, Roggini M, Magliulo G. Recurrent pyriform sinus fistula successfully treated by endoscopic Glubran 2 sealing: A rare case and literature review. SAGE Open Med Case Rep 2016; 4:2050313X16672151. [PMID: 27781098 PMCID: PMC5066581 DOI: 10.1177/2050313x16672151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 09/05/2016] [Indexed: 12/30/2022] Open
Abstract
Objectives: The authors present the case of a 3-year-old girl with a history of complicated surgery for removing a third branchial cleft fistula. Methods: An endoscopic approach using N-butyl-2-acrylate and metacrilosisolfolane glue (GLUBRAN 2) to seal the fistula was performed. Results: The clinical and radiological 6-year follow-up confirmed the absence of the fistulous orifice and the persistence of scar due to previous open-neck surgical procedures. Conclusion: endoscopic Glubran 2 sealing has been an effective treatment procedure for branchial fistula.
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Affiliation(s)
| | - Valentino Valentini
- Department of Maxillo-Facial Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Diletta Angeletti
- Organi di Senso Department, Sapienza University of Rome, Rome, Italy
| | - Simone Frediani
- Pediatric Surgery Unit, Sapienza University of Rome, Rome, Italy
| | | | - Denis Cozzi
- Pediatric Surgery Unit, Sapienza University of Rome, Rome, Italy
| | - Mario Roggini
- Servizio Speciale di Radiologia Pediatrica, Policlinico Umberto I, Università degli Studi La Sapienza, Roma, Italy
| | - Giuseppe Magliulo
- Organi di Senso Department, Sapienza University of Rome, Rome, Italy
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