Surgery versus endoscopic cauterization in patients with third or fourth branchial pouch sinuses: A systematic review

Abstract

The effectiveness of cauterization in preventing recurrence seems to be comparable to surgical treatment. However, we suggest endoscopic cauterization as the treatment of choice for third and fourth branchial pouch sinuses because of the lower morbidity rate.

Piriform sinus fistula management approach – our experience

“…Closure of the hypopharyngeal orifice can be acomplished by electrocauthery [13] or purse suture during surgical excision. Endoscopic cautherisation is described and seem less invasive than open cervical surgery in most of the cases but more procedures can be needed for definitive success [14].…”

Endoscopic Management of Recurrent Third Branchial Fistula using Histoacryl Glue

“…The latter two have been proven to be the most useful in diagnosis of 3rd and 4th branchial sinus. [4]The diagnostic accuracy of barium swallow can be improved by using thin contrast material and by performing the test when the fistula is not infected, thereby aiding the contrast to easily enter a non edematous tract. [5] In our case, a sinogram before the initial surgery confirmed the third branchial fistula and a barium swallow after the endoscopic cauterization showed its absence.…”

“…Various cauterization methods include chemocauterization with trichloroacetic acid, electrocauterization with monopolar diathermy, low power diode, CO2 laser, application of silver nitrate or fibrin glue. [2,4] A systematic review conducted by Derks et al, suggested that the treatment outcomes of cauterization was comparable to surgical management. [4] In our patient we used Histoacryl (n-Butyl cyanoacrylate ), a synthetic glue that has been used for wound closure and as an embolic agent in vascular interventions.…”

Rare finding of a fourth branchial cleft anomaly

“…Second arch anomalies are occasionally seen in head and neck clinics, presenting as cystic masses in the lateral compartment. Anomalies of the third and fourth arch presenting as anomalies of the pharynx are exceedingly rare, accounting for 1–8% of all branchial cleft anomalies . Less than 100 cases of fourth arch anomalies have been reported in the literature .…”

“…Initial management would involve drainage of the abscess or collection. Surgery with thyroid lobectomy and formal excision of the sinus tract or fistula is the definitive treatment to prevent recurrence and ensure a permanent cure …”