Fourth Branchial Sinus Causing Recurrent Cervical Abscess

Abstract

Background: Three patients who presented with recurrent cervical abscesses were found to have a branchial sinus arising in the piriform fossa. Each patient had previously had cervical abscess drainage procedures. Methods: A retrospective review of patients with recurrent cervical abscess and associated fourth branchial sinus was carried out. Results: In each case, imaging and endoscopy identified a sinus tract from the left piriform fossa. Neck exploration with hemithyroidectomy and excision of the sinus tract was performed without further recurrence of abscess. Conclusions: We believe these cases to represent a fourth branchial sinus. The relevant embryology and anatomy of the branchial apparatus is discussed and the pathways for the sinus and fistulous tracts of branchial sinus origin are reviewed. Branchial sinuses are uncommon, but should be considered as the underlying aetiology in patients who present with recurrent cervical abscesses.

Isolated oropharyngeal abscess with hypopharyngeal extension recurring 12 years after initial surgical management: A case report and review of the literature

“…Oropharyngeal abscesses are traditionally managed with a transoral approach but optimal techniques and postoperative management, particularly for recurrent abscesses, are lacking. 45 Established treatments are only available for recurrent abscesses that arise from congenital anomalies, such as branchial cleft anomalies 7 – 9 and pyriform sinus fistulas. 10 , 11 For these cases, surgical management of the underlying congenital anomaly successfully prevents further abscess recurrence.…”

“…A total of seven studies were included in the qualitative synthesis. [5][6][7][8][9][10][11] The studies were published from 1997 to 2020. The studies were published from 1997 to 2020.…”

Fourth branchial pouch sinus — an unusually late initial presentation

“…Typically a 4th branchial pouch sinus presents in the 1st decade of life as recurrent neck abscesses often involving the perithyroid space, recurrent suppurative thyroiditis [4][5][6][7] which may even require a hemithyroidectomy [8], recurrent pseudothyroiditis [9], retro pharyngeal abscess with recurrent cellulitis [10] which may extend to the mediastinum to form an abscess there [11], neonatal or pediatric respiratory distress with [12,2] stridor or even as an asymptomatic mass [12] or as an incidental radiological fi nding [12]. This condition is often misdiagnosed initially until recurrence of symptoms leads to further investigations and a defi nitive diagnosis.…”

Imaging evaluation of congenital pediatric neck pathologies

“…A course inferior to the superior laryngeal nerve and superior to the recurrent laryngeal nerve suggests a fourth pouch origin, while a course superior to the superior laryngeal nerve suggests a third pouch origin 25,26 . Termination or adherence of an anomalous sinus tract to the lateral aspect of the thyroid gland may suggest a fourth pouch origin, since the lateral thyroid primordia and superior parathyroid glands are derived from the fourth pouch 21,27 .…”