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Recurrent neck infection with branchial arch fistula in children.
Int J Pediatr Otorhinolaryngol. 2011 Sep; 75(9):1181-5.IJ

Abstract

OBJECTIVE

Acute suppurative neck infections associated with third or fourth branchial arch fistulas are frequently recurrent. Third and fourth branchial arch anomalies are much less common than those of second arch and usually present with left thyroid lobe inflammation. The authors present their experience with 15 cases of pyriform sinus fistulae (PSF) of third branchial arch origin and 3 cases of fourth arch origin, all of which presented as recurrent neck infection mainly on the left side.

METHODS

A retrospective review of 18 cases of third and fourth arch fistulae treated at JIPMER from 2005 to 2010. This study includes 18 patients with PSF diagnosed by the existence of fistulous tract radiologically and intraoperatively with pathological correlation. Neck exploration with excision of tract and left hemithyroidectomy was performed in all cases.

RESULTS

The patients consisted of 7 males and 11 females, and the ages ranged from 3 to 15 years. All of them presented with recurrent episodes of neck infection. Investigations performed include computed tomography (CT) fistulography, barium swallow and ultrasound which were useful in delineating pyriform sinus fistulous tract preoperatively. All cases were on the left side and the fistula was identified by barium swallow in 14 cases (80%), while intraoperative and pathologic confirmation of the tract was possible in all cases (100%). Neck exploration with an emphasis on complete exposure of the recurrent laryngeal nerve and exposure of the pyriform sinus opening to facilitate complete fistulous tract excision with left hemithyroidectomy was successful in all patients. A follow up period of 1-3 years showed no recurrence.

CONCLUSION

Recurrent neck infection in a child should alert the physician to the possibility of an underlying pyriform sinus fistula of branchial origin and CT fistulography should be performed after the resolution of the neck infection to delineate the tract anatomically.

Authors+Show Affiliations

Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605 006, India. maddyy@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

21763006

Citation

Madana, J, et al. "Recurrent Neck Infection With Branchial Arch Fistula in Children." International Journal of Pediatric Otorhinolaryngology, vol. 75, no. 9, 2011, pp. 1181-5.
Madana J, Yolmo D, Kalaiarasi R, et al. Recurrent neck infection with branchial arch fistula in children. Int J Pediatr Otorhinolaryngol. 2011;75(9):1181-5.
Madana, J., Yolmo, D., Kalaiarasi, R., Gopalakrishnan, S., Saxena, S. K., & Krishnapriya, S. (2011). Recurrent neck infection with branchial arch fistula in children. International Journal of Pediatric Otorhinolaryngology, 75(9), 1181-5. https://doi.org/10.1016/j.ijporl.2011.06.016
Madana J, et al. Recurrent Neck Infection With Branchial Arch Fistula in Children. Int J Pediatr Otorhinolaryngol. 2011;75(9):1181-5. PubMed PMID: 21763006.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recurrent neck infection with branchial arch fistula in children. AU - Madana,J, AU - Yolmo,Deeke, AU - Kalaiarasi,R, AU - Gopalakrishnan,S, AU - Saxena,S K, AU - Krishnapriya,S, Y1 - 2011/07/18/ PY - 2011/02/12/received PY - 2011/06/14/revised PY - 2011/06/18/accepted PY - 2011/7/19/entrez PY - 2011/7/19/pubmed PY - 2012/1/31/medline SP - 1181 EP - 5 JF - International journal of pediatric otorhinolaryngology JO - Int. J. Pediatr. Otorhinolaryngol. VL - 75 IS - 9 N2 - OBJECTIVE: Acute suppurative neck infections associated with third or fourth branchial arch fistulas are frequently recurrent. Third and fourth branchial arch anomalies are much less common than those of second arch and usually present with left thyroid lobe inflammation. The authors present their experience with 15 cases of pyriform sinus fistulae (PSF) of third branchial arch origin and 3 cases of fourth arch origin, all of which presented as recurrent neck infection mainly on the left side. METHODS: A retrospective review of 18 cases of third and fourth arch fistulae treated at JIPMER from 2005 to 2010. This study includes 18 patients with PSF diagnosed by the existence of fistulous tract radiologically and intraoperatively with pathological correlation. Neck exploration with excision of tract and left hemithyroidectomy was performed in all cases. RESULTS: The patients consisted of 7 males and 11 females, and the ages ranged from 3 to 15 years. All of them presented with recurrent episodes of neck infection. Investigations performed include computed tomography (CT) fistulography, barium swallow and ultrasound which were useful in delineating pyriform sinus fistulous tract preoperatively. All cases were on the left side and the fistula was identified by barium swallow in 14 cases (80%), while intraoperative and pathologic confirmation of the tract was possible in all cases (100%). Neck exploration with an emphasis on complete exposure of the recurrent laryngeal nerve and exposure of the pyriform sinus opening to facilitate complete fistulous tract excision with left hemithyroidectomy was successful in all patients. A follow up period of 1-3 years showed no recurrence. CONCLUSION: Recurrent neck infection in a child should alert the physician to the possibility of an underlying pyriform sinus fistula of branchial origin and CT fistulography should be performed after the resolution of the neck infection to delineate the tract anatomically. SN - 1872-8464 UR - https://www.unboundmedicine.com/medline/citation/21763006/Recurrent_neck_infection_with_branchial_arch_fistula_in_children_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-5876(11)00293-X DB - PRIME DP - Unbound Medicine ER -