In a select number of clinically stable children, deep neck abscesses diagnosed on contrast-enhanced CT scans using strict radiographic criteria can be effectively treated with intravenous antibiotics alone.

To evaluate the effectiveness of endoscopic cauterization as definitive treatment for fourth branchial cleft sinuses. Design: Retrospective chart review with follow-up questionnaire. Setting: Tertiary care children's hospital. Patients: Ten children (age range, 10 months to 10 years) with fourth branchial cleft sinuses treated with endoscopic cauterization between 1995 and 2002. Main Outcome Measure: Recurrence of neck infections after endoscopic cauterization of fourth brachial cleft sinus tracts. Results: Seven of the 10 patients treated with endoscopic cauterization of the fourth branchial cleft sinuses showed no recurrence with an average follow-up of 3 years. Three of the patients were unavailable for followup, but medical records of the hospital showed no additional admissions for those patients for neck masses. No morbidity of the procedure was identified. All patients were discharged the day of surgery. Conclusions: Endoscopic cauterization of fourth branchial cleft sinuses appears to be an effective alternative to open excision.

Children who have undergone liver transplantation and develop tonsillar hypertrophy should undergo a diagnostic tonsillectomy, regardless of the clinical presentation, to rule out a form of posttransplant lymphoproliferative disease. Arch Otolaryngol Head Neck Surg. 2000;126:1444-1447

Contrast-enhanced computed tomography may be an effective screening examination in this patient population, helping to determine which children should be admitted for angiography and observation.

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