Deep Neck Infections of Congenital Causes

Nour, Yasser A.; Hassan, Mohamed; Gaafar, Alaa; Eldaly, Ahmed

doi:10.1177/0194599810391629

Cited by 13 publications

(7 citation statements)

References 28 publications

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“…4 The term "fourth branchial pouch cyst" and its various permutations, which have traditionally been used to describe these anomalies, have lately fallen out of favor because of a lack of consensus about their origin. Echoing statements made by other authors, 7,10,14,17 we believe that the term "pyriform fossa sinus tract" best describes the important diagnostic feature of the abnormality and suggest its use to avoid confusion in the literature. Without neck dissection and definitive mapping of the tract, other nomenclature is merely speculative regarding the origin of the lesion.…”

Section: Discussionmentioning

confidence: 62%

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Endoscopic Cauterization of Congenital Pyriform Fossa Sinus Tracts

Sun

Berg

McClay

2014

JAMA Otolaryngol Head Neck Surg

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ranchial arch abnormalities opening into the pyriform fossa are an important congenital cause of recurrent neck abscesses in children. The classification and naming of these anomalies is controversial because of the complex embryological development of the region involved. In 1972, Sandborn and Shafer 1 first described a neck mass caused by a sinus tract traveling from the left pyriform fossa to the superior pole of the left lobe of the thyroid. The lesion was classified as a fourth branchial pouch derivative, which became the widely used term for such structures. 1 Theoretically, a complete fourth branchial pouch fistula tract would begin at the pyriform fossa, exit the larynx near the cricothyroid joint, and pass between the superior and recurrent laryngeal nerves behind the body of the thyroid gland. The fistula would then make a convoluted journey toward the mediastinum before looping back and exiting anterior to the sternocleidomastoid muscle on the lower neck. 2 To our knowledge, a complete fistula tract naturally opening onto the neck has never been reported. To complicate matters, fistula tracts arising from the third branchial pouch theoretically would also start at the pyriform fossa. However, the tract would pass cranial instead of caudal to the superior laryngeal nerve. 2Because of the difficulty of distinguishing third and fourth pouch tracts, some authors have chosen to consider them a single entity. More recently, the thymopharyngeal duct, a third pouch derivative independent of the third and fourth fistula tracts, has been alternatively proposed as the cause of these lesions. 3 The thymopharyngeal duct is formed when the thymus descends from the third pouch through the fourth arch to fuse with its contralateral counterpart during fetal development. Failure of thymopharyngeal duct involution should lead to a sinus tract containing thymus-derived tissue starting at the pyriform fossa and descending in close association with the thyroid. OBJECTIVE To evaluate the long-term effectiveness of endoscopic cauterization as definitive treatment for pyriform fossa sinus tracts. DESIGN, SETTING, AND PATIENTSRetrospective review of the medical records of 23 children (aged 7 months to 14 years) with pyriform fossa sinus tracts treated with endoscopic cauterization between 1995 and 2013 at a tertiary care children's hospital.INTERVENTION Endoscopic electrocauterization of pyriform fossa sinus tract opening. MAIN OUTCOMES AND MEASURESRecurrence of symptoms after endoscopic treatment.RESULTS Twenty-one of 23 patients experienced no recurrence after their first endoscopic electrocauterization of the sinus tract. The 2 patients with recurrence experienced symptoms within 1 month of cauterization and were treated with either open excision or recauterization. Endoscopic cauterization was able to definitively treat 9 patients whose treatments with incision and drainage or open excision had failed. Mean (range) follow-up for the 15 patients with follow-up was 7.4 (0.10-14.2) years. No procedure-related morbidity was re...

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Section: Discussionmentioning

confidence: 62%

“…5 Many more cases have been reported since then, although PFST prevalence has varied in reports from a number of individual institutions. [6][7][8] The sinus tracts occur equally in both sexes and overwhelmingly on the left side of the neck (94%). 5 Usually, PFST presents in young children as either acute suppurative thyroiditis or recurrent neck abscess.…”

mentioning

confidence: 99%

Endoscopic Cauterization of Congenital Pyriform Fossa Sinus Tracts

Sun

Berg

McClay

2014

JAMA Otolaryngol Head Neck Surg

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“…This view is supported by the increase of recurrences if infections precede operative treatment (12). A review of 249 deep neck infections revealed a congenital cause in 39 cases (16%) (13). No second branchial cleft sinuses/fistulae were observed, indicating that these sinuses and fistulae are extremely rare cause of deep neck infections.…”

Section: Discussionmentioning

confidence: 99%

Second Branchial Anomalies in Children and Literature Review

2017

GMJ

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Second branchial arches anomalies are the most common branchial anomalies. Usually sinuses and fistulas are encountered in younger ages, while cysts are observed in adolescent or adults. Early diagnosis and treatment decreases recurrence by preventing infection, which causes adhesions in the tissue plans. Definitive treatment for these lesions are surgical excision. The aim of this study is to report our clinical experience in second brachial duct anomalies with the review of the literature.

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“…4,21 US is difficult to interpret, is subject to the skill level of the operator, may not visualize deeper lesions, and does not provide the anatomic information necessary for planning the surgical approach to HNLMs. 24 The goal of US is often to determine the next best step, with options including clinical observation, follow-up US, CT, MRI, tissue sampling, surgical resection, embolization, and sclerosis. 20 In certain cases, CT may be also favored due to shorter imaging duration.…”

Section: Discussionmentioning

confidence: 99%

Imaging manifestations of head and neck lymphatic malformations: A single‐center experience of 170 surgical cases

Chen,

Xu,

Zhang

et al. 2024

Head & Neck

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ObjectivesTo discuss the imaging manifestations and the utility of preoperative ultrasonography (US), contrast‐enhanced computed tomography (CE‐CT) and contrast enhanced magnetic resonance imaging (CE‐MRI) in diagnosing the pediatric head and neck lymphatic malformations (HNLMs).MethodsWe performed a retrospective review of 170 children who were referred to our hospital in the past 9 years for the treatment of HNLMs.ResultsThe diagnostic rates of US, CE‐CT and CE‐MRI were 93.0% (146/157), 94.7% (143/151) and 100% (45/45), respectively. As in multilocular cases, intracystic septa detection rate was 91.5% (130/142), 50.4% (68/135) and 88.1% (37/42), and which had a statistical difference (χ2 = 25.8131, p < 0.05). US showed capsule contents anechoic in 51.0% (80/157) cases, hypoechoic or mixed echoic in 49.0% (77/157) cases, and flocculent or dotted echo floating in 36.9% (58/157) cases. CT showed low density of the capsule contents without enhancement in 69.5% (105/151) cases and mixed density with enhancement in 30.4% (46/151) cases. Liquid–liquid levers were seen in 8.6% (13/151) cases. MRI showed T1WI high signal and T2WI low signal of the capsule contents without enhancement in 28.9% (13/45) cases and mixed density in 71.1% (32/45) cases. Liquid–liquid levers were seen in 46.7% (21/45) cases. There were statistically significant differences between pure HNLMs and intracystic hemorrhage in capsule content (echo, density, signal), enhancement, and liquid–liquid lever (all p < 0.05). Among US, CE‐CT and CE‐MRI, intracystic hemorrhage diagnostic accuracy had a statistical difference (χ2 = 25.4152, p < 0.05).ConclusionsFor clinical diagnosis and evaluation of HNLMs, we suggest that US combined with CE‐CT for acute cases, and for stable cases, US combined with CE‐MRI.

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Deep Neck Infections of Congenital Causes

Cited by 13 publications

References 28 publications

Endoscopic Cauterization of Congenital Pyriform Fossa Sinus Tracts

Endoscopic Cauterization of Congenital Pyriform Fossa Sinus Tracts

Second Branchial Anomalies in Children and Literature Review

Imaging manifestations of head and neck lymphatic malformations: A single‐center experience of 170 surgical cases

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