Presentation in pediatric patients with allergic fungal sinusitis is different from that in adults, with children having obvious abnormalities of their facial skeleton, unilateral sinus disease, and asymmetrical disease more often. Findings on computed tomography scan show an equal amount of bony erosion with extension of disease. The types of fungus cultured in the sinus cavities are similar in both groups.
Fourth branchial cleft sinuses are rare, and the nature of their origin is controversial. Clinical presentation is varied because they may present as asymptomatic neck masses, recurrent neck abscesses, or suppurative thyroiditis. We describe herein 7 children who presented with abscesses on the left side of their necks, 3 of whom had abscesses that involved the thyroid gland. Direct laryngoscopy revealed that all 7 children had a sinus tract opening into the apex of the piriform sinus. Endoscopic obliteration of this tract was achieved using an insulated electrocautery probe either when the abscess was initially incised and drained or 4 to 6 weeks later. All 7 children recovered uneventfully. Four of the 7 children were followed up for more than 18 months without recurrence.
To evaluate the effectiveness of endoscopic cauterization as definitive treatment for fourth branchial cleft sinuses. Design: Retrospective chart review with follow-up questionnaire. Setting: Tertiary care children's hospital. Patients: Ten children (age range, 10 months to 10 years) with fourth branchial cleft sinuses treated with endoscopic cauterization between 1995 and 2002. Main Outcome Measure: Recurrence of neck infections after endoscopic cauterization of fourth brachial cleft sinus tracts. Results: Seven of the 10 patients treated with endoscopic cauterization of the fourth branchial cleft sinuses showed no recurrence with an average follow-up of 3 years. Three of the patients were unavailable for followup, but medical records of the hospital showed no additional admissions for those patients for neck masses. No morbidity of the procedure was identified. All patients were discharged the day of surgery. Conclusions: Endoscopic cauterization of fourth branchial cleft sinuses appears to be an effective alternative to open excision.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.