Endoscopic Cauterization of Fourth Branchial Cleft Sinus Tracts

Verret, D. J.; McClay, John E.; Murray, Alan D.; Biavati, Michael J.; Brown, Orval E.

doi:10.1001/archotol.130.4.465

Cited by 56 publications

(70 citation statements)

References 9 publications

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“…4 However, a 2008 literature review found 526 published cases of PFST, 5-fold more than previously thought to exist. 5 Many more cases have been reported since then, although PFST prevalence has varied in reports from a number of individual institutions.…”

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confidence: 99%

Endoscopic Cauterization of Congenital Pyriform Fossa Sinus Tracts

Sun

Berg

McClay

2014

JAMA Otolaryngol Head Neck Surg

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ranchial arch abnormalities opening into the pyriform fossa are an important congenital cause of recurrent neck abscesses in children. The classification and naming of these anomalies is controversial because of the complex embryological development of the region involved. In 1972, Sandborn and Shafer 1 first described a neck mass caused by a sinus tract traveling from the left pyriform fossa to the superior pole of the left lobe of the thyroid. The lesion was classified as a fourth branchial pouch derivative, which became the widely used term for such structures. 1 Theoretically, a complete fourth branchial pouch fistula tract would begin at the pyriform fossa, exit the larynx near the cricothyroid joint, and pass between the superior and recurrent laryngeal nerves behind the body of the thyroid gland. The fistula would then make a convoluted journey toward the mediastinum before looping back and exiting anterior to the sternocleidomastoid muscle on the lower neck. 2 To our knowledge, a complete fistula tract naturally opening onto the neck has never been reported. To complicate matters, fistula tracts arising from the third branchial pouch theoretically would also start at the pyriform fossa. However, the tract would pass cranial instead of caudal to the superior laryngeal nerve. 2Because of the difficulty of distinguishing third and fourth pouch tracts, some authors have chosen to consider them a single entity. More recently, the thymopharyngeal duct, a third pouch derivative independent of the third and fourth fistula tracts, has been alternatively proposed as the cause of these lesions. 3 The thymopharyngeal duct is formed when the thymus descends from the third pouch through the fourth arch to fuse with its contralateral counterpart during fetal development. Failure of thymopharyngeal duct involution should lead to a sinus tract containing thymus-derived tissue starting at the pyriform fossa and descending in close association with the thyroid. OBJECTIVE To evaluate the long-term effectiveness of endoscopic cauterization as definitive treatment for pyriform fossa sinus tracts. DESIGN, SETTING, AND PATIENTSRetrospective review of the medical records of 23 children (aged 7 months to 14 years) with pyriform fossa sinus tracts treated with endoscopic cauterization between 1995 and 2013 at a tertiary care children's hospital.INTERVENTION Endoscopic electrocauterization of pyriform fossa sinus tract opening. MAIN OUTCOMES AND MEASURESRecurrence of symptoms after endoscopic treatment.RESULTS Twenty-one of 23 patients experienced no recurrence after their first endoscopic electrocauterization of the sinus tract. The 2 patients with recurrence experienced symptoms within 1 month of cauterization and were treated with either open excision or recauterization. Endoscopic cauterization was able to definitively treat 9 patients whose treatments with incision and drainage or open excision had failed. Mean (range) follow-up for the 15 patients with follow-up was 7.4 (0.10-14.2) years. No procedure-related morbidity was re...

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confidence: 99%

Endoscopic Cauterization of Congenital Pyriform Fossa Sinus Tracts

Sun

Berg

McClay

2014

JAMA Otolaryngol Head Neck Surg

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“…Por estas razones, se recomienda realizar una laringoscopía directa ante la sospecha de una anomalía de cuarto arco branquial 21 . Se describe también que al realizar la maniobra de valsalva durante una tomografía computarizada o un esofagograma con bario, podría ayudar a abrir el trayecto sinusal tornándose éste más visible 22,23 . Además queremos destacar la utilidad del estudio con nasolaringofibroscopía en nuestra serie, mediante el cual fue posible observar edema del seno piriforme comprometido en dos de los casos, lo que orientó aún más la sospecha diagnóstica.…”

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“…Por otro lado, la resección quirúrgica de la lesión branquial, particularmente cuando se ha asociado a tiroidectomía parcial ha presentado tasas de recurrencia significativamente menores, sin embargo, este manejo presenta mayores tasas de complicaciones particularmente en menores de 8 años 13 . El tratamiento endoscópico, reportado en 62 casos 13 , representa una técnica mínimamente invasiva en la cual se cauteriza y oblitera la apertura del trayecto fistuloso en el seno piriforme 13,23 . Esta técnica ha demostrado tasas de recurrencia similares respecto a cirugía abierta de cuello y resección de la lesión, con menores tasas de complicaciones y menor costo 13 .…”

Section: Discussionunclassified

Manejo endoscópico de anomalías del cuarto arco branquial: Reporte de tres casos

et al. 2017

Rev. Otorrinolaringol. Cir. Cabeza Cuello

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“…12 Endoscopic cauterization of the fourth branchial cleft sinus has been reported with effective result compared with open excision. 13 Treatment by chemocauterization of the internal opening with trichloroacetic acid (TCA) has been reported with encouraging results. 2,14 In 2009, Nixon and Healey reported the role of sclerotherapy for treatment of branchial sinus tract.…”

Section: Discussionmentioning

confidence: 99%

Complete Congenital Third Branchial Fistula: A Rare Case Report

Gawai¹,

Kumar²,

Sangole³

et al. 2011

An International Journal of Otorhinolaryngology Clinics

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Fistulae arising from the second branchial apparatus are the most common anomalies than those arising from the third and fourth branchial apparatus. Third branchial fistula is extremely rare in occurrence.1 Complete fistulae are uncommon as in the majority of cases the tracts end blindly. Here, we report a case of complete congenital third branchial fistula on left side of the neck with an internal opening near left pyriform fossa in a 12-year-old male patient.

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Endoscopic Cauterization of Fourth Branchial Cleft Sinus Tracts

Cited by 56 publications

References 9 publications

Endoscopic Cauterization of Congenital Pyriform Fossa Sinus Tracts

Endoscopic Cauterization of Congenital Pyriform Fossa Sinus Tracts

Manejo endoscópico de anomalías del cuarto arco branquial: Reporte de tres casos

Complete Congenital Third Branchial Fistula: A Rare Case Report

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