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Pediatric recurrent acute suppurative thyroiditis of third branchial arch origin--our experience in 17 cases.
Int J Pediatr Otorhinolaryngol. 2014 Nov; 78(11):1953-7.IJ

Abstract

OBJECTIVE

To describe clinical presentations, management and treatment outcomes of 17 cases of congenital pyriform sinus fistula (PSF) of third branchial arch origin presenting as left recurrent acute suppurative thyroiditis with cervical abscess.

METHOD

Medical record of these 17 cases (5-males, 12-females) presented during 2009-2013 were reviewed.

RESULTS

Average age was 9.6 years (range 3-15 years). Fistulous opening in neck was present in 10 cases (58.8%). Average number of episode of infection from first presentation to definitive diagnosis was 3 (range 2-5). All patient had history of incision and drainage (ID) of abscess (average 2, range 1-3). All cases had barium swallow and CT scan. Sixteen cases had telescopic hypopharyngoscopy. Barium swallow and telescopic hypopharyngoscopy detected PSF in 88.23% (15/17) and 100% (16/16) cases respectively. Fourteen cases were treated by transcervical excision (TE) (fistulectomy with left hemithyroidectomy), two cases were treated by endoscopic chemical cauterization (ECC) of internal opening at pyriform sinus using silver nitrate and only ID of abscess was done in one case. Success rate of TE and ECC was 93% and 100% respectively. Recurrence in one case initially treated by TE was managed successfully by ECC.

CONCLUSION

Presence of congenital PFS should be suspected when left-sided intra-thyroidal abscess formation occurs as gland is resistant to infection. Strong clinical suspicion, barium swallow study, telescopic pharyngoscopy and CT scan are the key to diagnosis. Both TE and ECC has comparable success rate. ECC may prove a useful and equally effective method of treatment for congenital PFS in future.

Authors+Show Affiliations

Department of Otorhinolaryngology and Head-Neck Surgery, JIPMER, Puducherry, India. Electronic address: drpradipta04@gmail.com.Department of Otorhinolaryngology and Head-Neck Surgery, JIPMER, Puducherry, India.Department of Otorhinolaryngology and Head-Neck Surgery, JIPMER, Puducherry, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25219934

Citation

Parida, Pradipta Kumar, et al. "Pediatric Recurrent Acute Suppurative Thyroiditis of Third Branchial Arch Origin--our Experience in 17 Cases." International Journal of Pediatric Otorhinolaryngology, vol. 78, no. 11, 2014, pp. 1953-7.
Parida PK, Gopalakrishnan S, Saxena SK. Pediatric recurrent acute suppurative thyroiditis of third branchial arch origin--our experience in 17 cases. Int J Pediatr Otorhinolaryngol. 2014;78(11):1953-7.
Parida, P. K., Gopalakrishnan, S., & Saxena, S. K. (2014). Pediatric recurrent acute suppurative thyroiditis of third branchial arch origin--our experience in 17 cases. International Journal of Pediatric Otorhinolaryngology, 78(11), 1953-7. https://doi.org/10.1016/j.ijporl.2014.08.034
Parida PK, Gopalakrishnan S, Saxena SK. Pediatric Recurrent Acute Suppurative Thyroiditis of Third Branchial Arch Origin--our Experience in 17 Cases. Int J Pediatr Otorhinolaryngol. 2014;78(11):1953-7. PubMed PMID: 25219934.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pediatric recurrent acute suppurative thyroiditis of third branchial arch origin--our experience in 17 cases. AU - Parida,Pradipta Kumar, AU - Gopalakrishnan,Surianarayanan, AU - Saxena,Sunil Kumar, Y1 - 2014/09/01/ PY - 2014/05/10/received PY - 2014/07/29/revised PY - 2014/08/24/accepted PY - 2014/9/16/entrez PY - 2014/9/16/pubmed PY - 2015/12/29/medline KW - Branchial arch KW - Fistula KW - Pyriform sinus KW - Thyroidectomy KW - Thyroiditis SP - 1953 EP - 7 JF - International journal of pediatric otorhinolaryngology JO - Int. J. Pediatr. Otorhinolaryngol. VL - 78 IS - 11 N2 - OBJECTIVE: To describe clinical presentations, management and treatment outcomes of 17 cases of congenital pyriform sinus fistula (PSF) of third branchial arch origin presenting as left recurrent acute suppurative thyroiditis with cervical abscess. METHOD: Medical record of these 17 cases (5-males, 12-females) presented during 2009-2013 were reviewed. RESULTS: Average age was 9.6 years (range 3-15 years). Fistulous opening in neck was present in 10 cases (58.8%). Average number of episode of infection from first presentation to definitive diagnosis was 3 (range 2-5). All patient had history of incision and drainage (ID) of abscess (average 2, range 1-3). All cases had barium swallow and CT scan. Sixteen cases had telescopic hypopharyngoscopy. Barium swallow and telescopic hypopharyngoscopy detected PSF in 88.23% (15/17) and 100% (16/16) cases respectively. Fourteen cases were treated by transcervical excision (TE) (fistulectomy with left hemithyroidectomy), two cases were treated by endoscopic chemical cauterization (ECC) of internal opening at pyriform sinus using silver nitrate and only ID of abscess was done in one case. Success rate of TE and ECC was 93% and 100% respectively. Recurrence in one case initially treated by TE was managed successfully by ECC. CONCLUSION: Presence of congenital PFS should be suspected when left-sided intra-thyroidal abscess formation occurs as gland is resistant to infection. Strong clinical suspicion, barium swallow study, telescopic pharyngoscopy and CT scan are the key to diagnosis. Both TE and ECC has comparable success rate. ECC may prove a useful and equally effective method of treatment for congenital PFS in future. SN - 1872-8464 UR - https://www.unboundmedicine.com/medline/citation/25219934/Pediatric_recurrent_acute_suppurative_thyroiditis_of_third_branchial_arch_origin__our_experience_in_17_cases_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-5876(14)00478-9 DB - PRIME DP - Unbound Medicine ER -