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Management of congenital fourth branchial arch anomalies: a review and analysis of published cases.
J Pediatr Surg. 2009 Jul; 44(7):1432-9.JP

Abstract

BACKGROUND/PURPOSE

Congenital fourth branchial arch anomalies are uncommon entities, heretofore described only in case reports, affecting primarily children, and typically presenting as a cervical inflammatory process. The aim of the study was to collect appropriate data on the diagnosis, treatment, and outcome of this condition and to suggest guidelines for its management.

METHODS

We conducted a structured review of the literature for cases explicitly identified as congenital fourth branchial arch anomalies or meeting anatomical criteria for this condition. We computed descriptive statistics and performed several post hoc 2-way comparisons of subgroups of cases.

RESULTS

We located and critically evaluated 526 cases. Fourth arch anomalies were usually located on the left (94%) and generally presented as acute suppurative thyroiditis (45%) or recurrent neck abscess (42%). Barium swallow and direct laryngoscopy were the most useful diagnostic tools. Treatment options differed mainly in recurrence rates: incision and drainage, 89%; open neck surgery and tract excision, 15%; endoscopic cauterization of the sinus tract opening, 15%; and open neck surgery with partial thyroidectomy, 8%. Complications after surgery occurred primarily in children 8 years or younger.

CONCLUSION

Fourth arch anomalies are more common than once thought. Treatment of these disorders with repeated incision and drainage yields high rates of recurrence; thus, complete excision of the entire fistula tract during a quiescent period appears preferable. Combining this surgery with partial thyroidectomy may further decrease recurrence rates. Complications can likely be minimized by using antibiotic treatment of acute infections or endoscopic cauterization in children 8 years or younger, and delaying open neck surgery.

Authors+Show Affiliations

Department of Otolaryngology, Head and Neck Surgery, University Hospital, 1211 Geneva, Switzerland. keyvan_nicoucar@meei.harvard.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

19573674

Citation

Nicoucar, Keyvan, et al. "Management of Congenital Fourth Branchial Arch Anomalies: a Review and Analysis of Published Cases." Journal of Pediatric Surgery, vol. 44, no. 7, 2009, pp. 1432-9.
Nicoucar K, Giger R, Pope HG, et al. Management of congenital fourth branchial arch anomalies: a review and analysis of published cases. J Pediatr Surg. 2009;44(7):1432-9.
Nicoucar, K., Giger, R., Pope, H. G., Jaecklin, T., & Dulguerov, P. (2009). Management of congenital fourth branchial arch anomalies: a review and analysis of published cases. Journal of Pediatric Surgery, 44(7), 1432-9. https://doi.org/10.1016/j.jpedsurg.2008.12.001
Nicoucar K, et al. Management of Congenital Fourth Branchial Arch Anomalies: a Review and Analysis of Published Cases. J Pediatr Surg. 2009;44(7):1432-9. PubMed PMID: 19573674.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of congenital fourth branchial arch anomalies: a review and analysis of published cases. AU - Nicoucar,Keyvan, AU - Giger,Roland, AU - Pope,Harrison G,Jr AU - Jaecklin,Thomas, AU - Dulguerov,Pavel, PY - 2008/10/05/received PY - 2008/12/01/revised PY - 2008/12/01/accepted PY - 2009/7/4/entrez PY - 2009/7/4/pubmed PY - 2009/9/30/medline SP - 1432 EP - 9 JF - Journal of pediatric surgery JO - J Pediatr Surg VL - 44 IS - 7 N2 - BACKGROUND/PURPOSE: Congenital fourth branchial arch anomalies are uncommon entities, heretofore described only in case reports, affecting primarily children, and typically presenting as a cervical inflammatory process. The aim of the study was to collect appropriate data on the diagnosis, treatment, and outcome of this condition and to suggest guidelines for its management. METHODS: We conducted a structured review of the literature for cases explicitly identified as congenital fourth branchial arch anomalies or meeting anatomical criteria for this condition. We computed descriptive statistics and performed several post hoc 2-way comparisons of subgroups of cases. RESULTS: We located and critically evaluated 526 cases. Fourth arch anomalies were usually located on the left (94%) and generally presented as acute suppurative thyroiditis (45%) or recurrent neck abscess (42%). Barium swallow and direct laryngoscopy were the most useful diagnostic tools. Treatment options differed mainly in recurrence rates: incision and drainage, 89%; open neck surgery and tract excision, 15%; endoscopic cauterization of the sinus tract opening, 15%; and open neck surgery with partial thyroidectomy, 8%. Complications after surgery occurred primarily in children 8 years or younger. CONCLUSION: Fourth arch anomalies are more common than once thought. Treatment of these disorders with repeated incision and drainage yields high rates of recurrence; thus, complete excision of the entire fistula tract during a quiescent period appears preferable. Combining this surgery with partial thyroidectomy may further decrease recurrence rates. Complications can likely be minimized by using antibiotic treatment of acute infections or endoscopic cauterization in children 8 years or younger, and delaying open neck surgery. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/19573674/Management_of_congenital_fourth_branchial_arch_anomalies:_a_review_and_analysis_of_published_cases_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3468(08)01080-4 DB - PRIME DP - Unbound Medicine ER -