Third or fourth branchial pouch sinus lesions: a case series and management algorithm

Abstract

BackgroundThe purpose of this study was to develop an effective management algorithm for lesions of third or fourth branchial sinuses.Study designCase series with chart review.MethodsData from patients who were identified as having third or fourth branchial pouch sinus lesions in a single institution between January 2014 and December 2018 were retrospectively collected.ResultsAll 67 patients underwent fistulectomy. First, we classified the patients into five types based on their anatomic features. Then, we considered four optimized surgical methods and adopted the appropriate method with full consideration of the patient’s clinical characteristics. The great majority of cases occurred on the left side of the neck (68.7%) and most commonly presented as either a recurrent low-neck abscess or cutaneous discharging fistula with neck infection. Effective preoperative examination included administering contrast agent prior to a computed tomography (CT) scan and in-office laryngoscopy during the quiescent period of inflammation. Ultrasound was also very helpful in determining the presence of thyroiditis. The mean follow-up duration after excision of the lesion was 25.8 months. To date, only 1 (1.5%) recurrence and no obvious complications have been observed.ConclusionRefining fistula subtypes and adopting corresponding treatment measures can reduce the recurrence rate and improve curative effects. We propose and advocate this treatment algorithm for all third and fourth branchial pouch lesions.

Surgical treatment of fourth branchial apparatus anomalies: A case series study

“…And intra-operative direct laryngoscope is the best method to locate the internal orifice, because pyriform fossa can be better exposed and examined under general anesthesia, as shown in our cohort to be effective in 9 (90%) cases. Effectiveness was reported to be 61.2% (70% in our series) for fiberoptic laryngoscope [ 25 ]. And effectiveness of barium swallow X-ray was reported to be 61.2% by Li Y. et al [ 25 ], or 75.0% (6/8) by Lu W.H.…”

“…Effectiveness was reported to be 61.2% (70% in our series) for fiberoptic laryngoscope [ 25 ]. And effectiveness of barium swallow X-ray was reported to be 61.2% by Li Y. et al [ 25 ], or 75.0% (6/8) by Lu W.H. et al [ 20 ], while it is 50.0% (5/10) in our series.…”

“…It is our experience that blue dying and identification of entire tracts, especially their entry points into the hypopharynx from inside the cervical surgical field, with pharyngeal confirmation through direct laryngoscope, was the key for complete resection and recurrence prevention of fourth branchial apparatus anomalies. Although some authors did not use blue dying of tracts in their procedures, especially those that only cauterize internal orifices [ 19 , 24 ]; other authors advocate the use of blue dying in the identification of the filiform tract within the fibrous tissue to achieve complete excision, especially in open neck procedures [ 14 , 25 ].…”

The congenital sternoclavicular sinus: a single-institution retrospective study of 88 patients

“…Both third and fourth branchial anomalies are rare congenital malformation of the neck. These fistulas enter the pyriform sinus and their clinical differentiation is difficult [ 20 ]. The fourth arch anomaly usually presents as cyst in newborn and suppurative thyroiditis outside the neonatal period [ 21 ].…”

The Congenital Sternoclavicular Sinus: a Single-institution Retrospective Study of 88 Patients

“…These stulas enter the pyriform sinus and are di cult to differentiate them in clinic. [20] The fourth arch anomaly usually presents as cyst in newborn and suppurative thyroiditis outside the neonatal period. [21] Most of the symptomatic pyriform sinuses (more than 90%) located on the left side.…”