Endoscopic Cauterization for Treatment of Fourth Branchial Cleft Sinuses

Jordan, Jennifer A.; Graves, Joe E.; Manning, Scott C.; McClay, John E.; Biavati, Michael J.

doi:10.1001/archotol.124.9.1021

Cited by 102 publications

(95 citation statements)

References 8 publications

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“…We first proposed endoscopic electrocauterization as a definitive treatment for PFST in 1998 and subsequently reported on 10 cases involving the procedure in 2004. 4,11 The procedure is described in detail in our previous reports. 4,11 With continued clinical experience since our initial report, we have found that cauterization alone without balloon dilation of the sinus tract seems to be equally efficacious ( Figure 1).…”

mentioning

confidence: 99%

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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confidence: 99%

Endoscopic Cauterization of Congenital Pyriform Fossa Sinus Tracts

Sun

Berg

McClay

2014

JAMA Otolaryngol Head Neck Surg

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“…This technique has been also successfully applied in four of five newborns by Leboulanger et al, 4 and has been reported in a recent publication. However, other endoscopic techniques have also been successfully performed by other authors in older children using electrocauterization, 15 trichloroacetic acid 16 or silver nitrate. 7 Although rare, the neonatal form of a fourth branchial pouch anomaly is a clinical entity that should be known by pediatric practitioners.…”

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confidence: 99%

Right fourth branchial cyst presenting as retropharyngeal collection in a neonate

et al. 2012

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“…One month after the drainage operation, Therefore, we diagnosed this case as left pyriform sinus fistula infection resulting in a deep neck infection and acute suppurative thyroiditis. Recently, an endoscopic chemocauterization technique has been described [4][5][6][7]. However, because we consider that operative excision of the entire tract, including the adjacent thyroid tissue, is essential to prevent recurrence, we performed a surgery using a lateral cervical approach.…”

Section: Case Reportmentioning

confidence: 99%

A Case of Second Branchial Cleft Sinus with Double Opening from the Tonsil

Kim¹,

Lee²

2018

Korean J Otorhinolaryngol-Head Neck Surg

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Pyriform sinus fistula is a rare clinical entity and the precise origin remains controversial. The fistula is discovered among patients with acute suppurative thyroiditis or deep neck infection of the left side of the neck and is usually located in the left pyriform sinus. To the best of our knowledge, only a single tract has been reported to be responsible for pyriform sinus fistula infection. We present a case of a 13-year-old female patient with a pyriform sinus fistula that caused a deep infection of the left side of the neck and showed double-tract involvement discovered during surgical resection of the entire fistula. Both tracts arose around the pyriform sinus and terminated at the upper portion of the left lobe of the thyroid.

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Endoscopic Cauterization for Treatment of Fourth Branchial Cleft Sinuses

Cited by 102 publications

References 8 publications

Endoscopic Cauterization of Congenital Pyriform Fossa Sinus Tracts

Endoscopic Cauterization of Congenital Pyriform Fossa Sinus Tracts

Right fourth branchial cyst presenting as retropharyngeal collection in a neonate

A Case of Second Branchial Cleft Sinus with Double Opening from the Tonsil

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