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Case series: Endoscopic management of fourth branchial arch anomalies.
Int J Pediatr Otorhinolaryngol. 2013 May; 77(5):766-9.IJ

Abstract

INTRODUCTION

Fourth branchial arch anomalies represent <1% of all branchial anomalies and present as recurrent neck infections or suppurative thyroiditis. Traditionally, management has consisted of treatment of the acute infection followed by hemithyroidectomy, surgical excision of the tract and obliteration of the opening in the pyriform fossa. Recently, it has been suggested that endoscopic obliteration of the sinus tract alone using laser, chemo or electrocautery is a viable alternative to open surgery.

OBJECTIVES

To determine the results of endoscopic obliteration of fourth branchial arch fistulae in children in our institute.

METHODS

Retrospective case note review of all children undergoing endoscopic treatment of fourth branchial arch anomalies in the last 7 years at the Royal Manchester Children's Hospital. Patient demographics, presenting symptoms, investigations and surgical technique were analysed. The primary and secondary outcome measures were resolution of recurrent infections and incidence of surgical complications, respectively.

RESULTS

In total 5 cases were identified (4 females and 1 male) aged between 3 and 12 years. All presented with recurrent left sided neck abscesses. All children underwent a diagnostic laryngo-tracheo-bronchoscopy which identified a sinus in the apex of the left pyriform fossa. This was obliterated using electrocautery in 1 patient, CO₂ laser/Silver Nitrate chemocautery in 2 patients and Silver Nitrate chemocautery in a further 2 patients. There were no complications and no recurrences over a mean follow-up period of 25 months (range 11-41 months).

CONCLUSION

Endoscopic obliteration of pyriform fossa sinus is a safe method for treating fourth branchial arch anomalies with no recurrence.

Authors+Show Affiliations

Royal Manchester Children's Hospital, United Kingdom.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23478017

Citation

Watson, G J., et al. "Case Series: Endoscopic Management of Fourth Branchial Arch Anomalies." International Journal of Pediatric Otorhinolaryngology, vol. 77, no. 5, 2013, pp. 766-9.
Watson GJ, Nichani JR, Rothera MP, et al. Case series: Endoscopic management of fourth branchial arch anomalies. Int J Pediatr Otorhinolaryngol. 2013;77(5):766-9.
Watson, G. J., Nichani, J. R., Rothera, M. P., & Bruce, I. A. (2013). Case series: Endoscopic management of fourth branchial arch anomalies. International Journal of Pediatric Otorhinolaryngology, 77(5), 766-9. https://doi.org/10.1016/j.ijporl.2013.02.007
Watson GJ, et al. Case Series: Endoscopic Management of Fourth Branchial Arch Anomalies. Int J Pediatr Otorhinolaryngol. 2013;77(5):766-9. PubMed PMID: 23478017.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Case series: Endoscopic management of fourth branchial arch anomalies. AU - Watson,G J, AU - Nichani,J R, AU - Rothera,M P, AU - Bruce,I A, Y1 - 2013/03/09/ PY - 2012/11/13/received PY - 2013/02/04/revised PY - 2013/02/06/accepted PY - 2013/3/13/entrez PY - 2013/3/13/pubmed PY - 2013/12/18/medline SP - 766 EP - 9 JF - International journal of pediatric otorhinolaryngology JO - Int J Pediatr Otorhinolaryngol VL - 77 IS - 5 N2 - INTRODUCTION: Fourth branchial arch anomalies represent <1% of all branchial anomalies and present as recurrent neck infections or suppurative thyroiditis. Traditionally, management has consisted of treatment of the acute infection followed by hemithyroidectomy, surgical excision of the tract and obliteration of the opening in the pyriform fossa. Recently, it has been suggested that endoscopic obliteration of the sinus tract alone using laser, chemo or electrocautery is a viable alternative to open surgery. OBJECTIVES: To determine the results of endoscopic obliteration of fourth branchial arch fistulae in children in our institute. METHODS: Retrospective case note review of all children undergoing endoscopic treatment of fourth branchial arch anomalies in the last 7 years at the Royal Manchester Children's Hospital. Patient demographics, presenting symptoms, investigations and surgical technique were analysed. The primary and secondary outcome measures were resolution of recurrent infections and incidence of surgical complications, respectively. RESULTS: In total 5 cases were identified (4 females and 1 male) aged between 3 and 12 years. All presented with recurrent left sided neck abscesses. All children underwent a diagnostic laryngo-tracheo-bronchoscopy which identified a sinus in the apex of the left pyriform fossa. This was obliterated using electrocautery in 1 patient, CO₂ laser/Silver Nitrate chemocautery in 2 patients and Silver Nitrate chemocautery in a further 2 patients. There were no complications and no recurrences over a mean follow-up period of 25 months (range 11-41 months). CONCLUSION: Endoscopic obliteration of pyriform fossa sinus is a safe method for treating fourth branchial arch anomalies with no recurrence. SN - 1872-8464 UR - https://www.unboundmedicine.com/medline/citation/23478017/Case_series:_Endoscopic_management_of_fourth_branchial_arch_anomalies_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-5876(13)00067-0 DB - PRIME DP - Unbound Medicine ER -