Fourth branchial pouch sinus: Principles of diagnosis and management

Godin, Michael S.; Kearns, David R.; Pransky, Seth M.; Seid, Allan B.; Wilson, Doris B.

doi:10.1288/00005537-199002000-00012

Cited by 117 publications

(17 citation statements)

References 12 publications

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“…The classic description is based on an understanding of the segmental branchial anatomy and involves persistence of the pharyngobranchial duct, which connects the third and fourth pharyngeal pouches to the pharynx and normally degenerates during the seventh week of development. Persistence of this duct results in a sinus tract that communicates with the pyriform fossa, representing persistence of both branchial cleft and corresponding pouch [1, 2]. …”

Section: Discussionmentioning

confidence: 99%

Right-Sided Pyriform Sinus Fistula: A Case Report and Review of the Literature

Cain

Kasznica

Brundage

2012

Case Reports in Otolaryngology

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Objectives. Pyriform sinus fistulae arise from disturbances in the development of the fetal third and fourth branchial pouches and are predominantly found on the left side. We report the rare case of a right-sided pyriform sinus fistula presenting as a lateral neck abscess. Study Design. Case report. Methods. A 24-year-old woman presented with a two-week history of right-sided neck abscess. A fluoroscopic sinogram revealed a fistulous tract extending from the abscess to the apex of the right pyriform sinus. It was determined that the fistula was likely a third or fourth branchial remnant, a rare right-sided finding. Chemocauterization of the fistulous tract with 40% trichloroacetic acid was used to successfully treat the patient. Results. Approximately 93–97% of branchial pouch anomalies are left sided. Treatment options include surgical excision and cauterization. Conclusions. Branchial cleft cyst and pyriform sinus fistula must be considered in the diagnosis of cervical abscess in either side of the neck.

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Section: Discussionmentioning

confidence: 99%

Right-Sided Pyriform Sinus Fistula: A Case Report and Review of the Literature

Cain

Kasznica

Brundage

2012

Case Reports in Otolaryngology

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“…Then it passes between the thyroid and cricoid cartilages and opens in to the pyriform fossa. According to Godin et al [17], almost all the fourth arch anomalies reported occurred in the left side. In our series also, the fourth arch fistula occurred in the left side.…”

Section: Individual Branchial Anomaliesmentioning

confidence: 99%

Branchial Anomalies: Diagnosis and Management

Prasad

Azeez

Thada

et al. 2014

International Journal of Otolaryngology

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Objective. To find out the incidence of involvement of individual arches, anatomical types of lesions, the age and sex incidence, the site and side of predilection, the common clinical features, the common investigations, treatment, and complications of the different anomalies. Setting. Academic Department of Otolaryngology, Head and Neck Surgery. Design. A 10 year retrospective study. Participants. 30 patients with clinically proven branchial anomalies including patients with bilateral disease totaling 34 lesions. Main Outcome Measures. The demographical data, clinical features, type of branchial anomalies, and the management details were recorded and analyzed. Results and Observations. The mean age of presentation was 18.67 years. Male to female sex ratio was 1.27 : 1 with a male preponderance. Of the 34 lesions, maximum incidence was of second arch anomalies (50%) followed by first arch. We had two cases each of third and fourth arch anomalies. Only 1 (3.3%) patients of the 30 presented with lesion at birth. The most common pathological type of lesions was fistula (58.82%) followed by cyst. 41.18% of the lesions occurred on the right side. All the patients underwent surgical excision. None of our patients had involvement of facial nerve in first branchial anomaly. All patients had tracts going superficial to the facial nerve. Conclusion. Confirming the extent of the tract is mandatory before any surgery as these lesions pass in relation to some of the most vital structures of the neck. Surgery should always be the treatment option. injection of dye, microscopic removal and inclusion of surrounding tissue while excising the tract leads to a decreased incidence of recurrence.

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“…For the recurrent infections and unclear anatomy, it is difficult to reveal the whole sinus. Methylene blue, microscope guidance, probe guidance, nelaton catheter, and Fogarty catheter can be used to help exposure [21–25]. In this study, 5 patients (100%) successfully underwent complete excision of fistula, and 2 patients (40%) simultaneously underwent ipsilateral gland resection.…”

Section: Discussionmentioning

confidence: 91%

Clinical Study on the Etiology of Postthyroidectomy Skin Sinus Formation

Jin

Bao

Borkhuu

et al. 2017

Surgery Research and Practice

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Background. Thyroidectomy is one of the most frequently performed surgical procedures worldwide. Despite technical advances and high experience of thyroidectomy of specialized centers, it is still burdened by a significant rate of postoperative complications. Among them, the skin sinus formation is an extremely rare postthyroidectomy complication. Here, we first report the incidence of the skin sinus formation after thyroidectomy to identify the causes for skin sinus formation after thyroidectomy and to discuss its prevention and treatment options. Methods. A retrospective analysis was carried out of patients who underwent excision operation of fistula for postthyroidectomy skin sinus formation. Data were retrieved from medical records department of the Affiliated Hospital of Inner Mongolia Medical University. Results. Of the 5,686 patients who underwent thyroid surgery, only 5 patients (0.088%) had developed skin sinus formation. All 5 patients successfully underwent complete excision of fistula. Conclusion. Infection, foreign body, thyroid surgery procedure, combined disease, and iatrogenic factors may be related with skin sinus formation after thyroidectomy. To reduce the recurrence of postoperative infections and sinus formation, intra- and postoperative compliance with aseptic processing, intraoperative use absorbable surgical suture/ligature, repeated irrigation and drainage, and postoperative administration of anti-inflammatory treatment are to be followed.

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Fourth branchial pouch sinus: Principles of diagnosis and management

Cited by 117 publications

References 12 publications

Right-Sided Pyriform Sinus Fistula: A Case Report and Review of the Literature

Right-Sided Pyriform Sinus Fistula: A Case Report and Review of the Literature

Branchial Anomalies: Diagnosis and Management

Clinical Study on the Etiology of Postthyroidectomy Skin Sinus Formation

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