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Bee-See G, Anuar NA. Endoscopic diagnostic and therapeutic management of branchial cleft fistula type III & IV: a single tertiary centre experience. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08853-0. [PMID: 39073435 DOI: 10.1007/s00405-024-08853-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 07/15/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION To date, recurrent neck abscesses associated with branchial anomalies are treated using a variety of techniques. Management strategies may include various imaging modalities and surgical methods. Endoscopic assessment and electrocauterization are the preferred diagnostic modalities and treatment strategies that have recently gained widespread acceptance and popularity. METHODOLOGY AND RESULTS This was a retrospective review on patients' medical record from 2016 to 2023. Seven patients underwent endoscopic cauterization at our centre, a tertiary academic institution. Five of the patients (71.5%) achieved complete remission. Two patients experienced recurrence within 6 months that necessitated re-cauterization once but subsequently recovered completely. Currently, endoscopic management is the preferred approach compared to the typical open neck excision surgery as it is significantly less invasive, resulting in lesser morbidity and similar success rates. At presentation, all of them had ultrasound neck that suggestive of neck abscess. Computed tomography or magnetic resonance imaging unable to provide adequate information about the side of internal opening of fistula where only 3 out of 7 patients demonstrated tract up to the ipsilateral region of pyriform fossa. DISCUSSION Management outcomes of this limited case series showed the potential benefits of endoscopic cauterization as the minimally invasive therapeutic method for recurrent neck abscesses caused by third and fourth branchial cleft fistulas but also to suggest the possibility as the first diagnostic tool prior to imaging studies.
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Affiliation(s)
- Goh Bee-See
- Department of Otorhinolaryngology, Head & Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, 56000 Cheras Wilayah Persekutuan, Kuala Lumpur, Malaysia.
- Hospital Canselor Tuanku Mukhriz, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur, Malaysia.
| | - Noor Azrin Anuar
- Department of Otorhinolaryngology, Head & Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, 56000 Cheras Wilayah Persekutuan, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Mukhriz, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur, Malaysia
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Li C, Siu JM, Woodward M, Wolter NE. Respiratory distress in a neonate: Inflation of a third branchial anomaly with positive airway pressure. Clin Case Rep 2024; 12:e8752. [PMID: 38634088 PMCID: PMC11022297 DOI: 10.1002/ccr3.8752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/06/2024] [Accepted: 02/24/2024] [Indexed: 04/19/2024] Open
Abstract
Positive airway pressure from noninvasive ventilation is an essential tool for many pediatric patients with respiratory distress. We present a case of an unknown third branchial anomaly that was diagnosed following inflation with continuous positive airway pressure (CPAP), which exacerbated the infant's respiratory distress.
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Affiliation(s)
- Chantal Li
- University of TorontoTorontoOntarioCanada
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Tsur N, Elmograbi A, Levi L, Shpitzer T, Bachar G, Hod R, Sokolov M, Raveh E. Management of first branchial anomalies in children: 20 years of experience. Pediatr Surg Int 2024; 40:31. [PMID: 38193906 DOI: 10.1007/s00383-023-05615-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE Branchial cleft anomalies (BCAs) are common pediatric head and neck lesions; however, only 1-4% involve the first branchial cleft. The rare occurrence of first BCAs, their presentation at a young age, and the possible facial nerve involvement make diagnosis and treatment challenging. METHODS A retrospective chart review was conducted for children diagnosed with their first BCA between 2000 and 2020. Data on demographics, presenting symptoms, physical findings, imaging features, previous surgery, and treatment outcomes were collected and analyzed. RESULTS The cohort included 17 patients with a median age of 5 years at presentation. Seven (41%) had undergone previous surgical intervention before definitive surgery. Eight were classified as Work Type II anomalies, and nine as Work Type I. Sixteen patients (94%) underwent definitive surgical excision at a median age of 6.9. A parotid approach was used in 10 (62%), with dissection of the mass from the facial nerve, and a retro-auricular or end-aural approach was used in 6 (38%). Complete excision was achieved in 14/16 patients (88%). Three patients had transient facial nerve paresis postoperatively. Recurrence was noted in 3/16 patients (18%). Enhancement in imaging was positively correlated with post-operative complications (R = 0.463, P = 0.018). CONCLUSIONS First, BCA poses a diagnostic and surgical challenge; thus, definitive surgical treatment is often delayed. The surgical approach should be tailored to the type of anomaly (Work type I or II) and possible facial nerve involvement. Risk factors for post-operative complications are a history of recurrent infections and previous surgical interventions. The presence of contrast enhancement in preoperative imaging should alert surgeons to perioperative challenges and the risk of post-operative complications. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Nir Tsur
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, 39 Jabotinsky St., 4941492, Petach Tikva, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Aiman Elmograbi
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, 39 Jabotinsky St., 4941492, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lirit Levi
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, 39 Jabotinsky St., 4941492, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Thomas Shpitzer
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, 39 Jabotinsky St., 4941492, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gideon Bachar
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, 39 Jabotinsky St., 4941492, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Hod
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology-Head and Neck Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Meirav Sokolov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology-Head and Neck Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Eyal Raveh
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology-Head and Neck Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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4
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Wang HC, Yuan HW, Zeng CQ, Teng YS. Treatment of Work Type II Congenital First Branchial Cleft Anomalies: A Summary of 35 Cases. EAR, NOSE & THROAT JOURNAL 2023:1455613231218136. [PMID: 38084860 DOI: 10.1177/01455613231218136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
Objective: This study aims to summarize the data and treatment of 35 children with Work type II congenital first branchial cleft anomalies (CFBCAs) to provide significant insights into the correlation between these anomalies and the facial nerve. Methods: A total of 35 children diagnosed with Work type II CFBCAs who received treatment at the Department of Otolaryngology-Head and Neck Surgery at Shenzhen Children's Hospital from August 2017 to March 2023 were analyzed retrospectively. Pearson chi-square tests and Fisher's exact tests were used to examine the relationship between clinical characteristics and the location of the lesion, which included the superficial and deep surfaces as well as the area between the branches of the facial nerve. Results: All 35 children underwent open incision and complete resection of fistulae. During the surgery, the lesions were found to be in the superficial facial nerve in 12 (34.3%) cases, between branches in 5 (14.3%) cases, and in the deep facial nerve in 18 (51.4%) cases. In those patients, lesions in females, with a lower edge of the lesion located below the angle of the mandible and the presence of a tympanic membranous attachment, are more likely to be located deep to the facial nerve or between its branches. The difference is statistically significant (P = .007, .032, .015). Conclusion: The treatment principle of Work type II CFBCAs consists of achieving a quiescent stage of inflammation, followed by a complete resection of the lesion on the premise of preserving facial nerve function. Certain clinical features of this disease can predict the relationship between the lesion and the facial nerve. The lesions in females, with a lower edge of the lesion located below the angle of the mandible, non-cystic type of Olsen, and the presence of tympanic membranous attachment, tend to be located deep to the facial nerve or between its branches.
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Affiliation(s)
- Hao-Cheng Wang
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, China Medical University, Shenzhen, Guangdong, China
| | - Hu-Wei Yuan
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Chun-Qin Zeng
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, China Medical University, Shenzhen, Guangdong, China
| | - Yi-Shu Teng
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
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Chauhan I, Thakur S. Complete Second Branchial Fistula: A Rare Entity. Indian J Otolaryngol Head Neck Surg 2023; 75:2277-2280. [PMID: 37636742 PMCID: PMC10447773 DOI: 10.1007/s12070-023-03570-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/06/2023] [Indexed: 02/19/2023] Open
Abstract
Second branchial anomalies like branchial cyst, sinus or fistula are common lateral neck masses in pediatric age group but it is rare to encounter complete branchial fistula with external as well as internal openings. We present a case of 16 yrs old female patient with complete Branchial fistula which was diagnosed with the help of CT fistulogram and thereafter taken up for surgical excision of fistula under general anaesthesia. Histopathology confirmed the diagnosis of branchial fistula. In case of lateral neck mass with external opening in pediatric age group strong possibility of diagnosis of branchial fistula should be kept, timely management of the case improves the quality of life.
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Patigaroo SA, Hamid WU, Ahmed S, Dar NH, Showkat SA, Latoo MA. Complete Second Branchial Cleft Fistulas: A Clinicosurgical Experience. Indian J Otolaryngol Head Neck Surg 2023; 75:1517-1524. [PMID: 37636759 PMCID: PMC10447783 DOI: 10.1007/s12070-023-03565-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 02/02/2023] [Indexed: 03/08/2023] Open
Abstract
A complete second branchial fistula is very rare and has an internal opening at the tonsillar fossa and an external opening at the lower third of the sternocleidomastoid (SCM). Patients commonly present with persistent or intermittent mucoid or mucopurulent discharge from an external opening. The diagnosis is most often clinical and radiological investigations are rarely needed. Treatment of choice is complete surgical excision. The aim of this article is to aware young ENT surgeons of the various clinical and intraoperative surgical findings that can be encountered while dealing with these cases. This observational study was done for a period of 10 years. A total of 20 cases of fistula were included which intraoperatively had a complete track from tonsillar fossa to neck. Excision of the tract was carried out via combined transcervical and transoral approach under general anaesthesia using two incisions in stepladder pattern. Each patient was seen after one year of surgery to assess for any recurrence. Different findings of patients including age/sex at surgery, initial presentation, family history, laterality of the fistula tract, Intraoperative surgical findings, complications, and recurrences. were noted. Of the 20 patients, 13 (65%) were females and 7 (35%) were Females. Most common complaint was fistulous opening with intermittent discharge(15patients; 75%).Branchial cleft fistulae more commonly affected the right neck (14 patients, 78%) among unilateral cases and 2 patients (10%) had bilateral fistulae. No patient had associated congenital anomaly/syndrome, family history or and visible opening in tonsillar area. Glossopharyngeal nerve was identified in 12 cases and track was seen passing lateral to it except in one case. The internal opening of track was seen over posterior tonsillar pillar in 15 cases (75%) while in 5 patient the track was seen entering tonsillar tissue or bed. Tonsillectomy was done in 5 cases while not done in 15 cases where track was seen entering posterior pillar. All patients were seen at one year follow up. No recurrence was seen at one year of follow up. Complete second branchial cleft fistulae are rare. They are usually right sided and unilateral. The track passes between carotid bifurcation and invariably passes lateral to both glossopharyngeal and hypoglossal nerves. Track usually ends at the posterior tonsillar pillar. Tonsillectomy is not routinely indicated. Recurrences are not typically seen.
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Affiliation(s)
| | - Waqar ul Hamid
- Department of ENT, Government Medical College Srinagar, Srinagar, JK India
| | - Sahil Ahmed
- Department of ENT, Government Medical College Srinagar, Srinagar, JK India
| | - Nisar Hussain Dar
- Department of ENT, Government Medical College Srinagar, Srinagar, JK India
| | - Showkat A. Showkat
- Department of ENT, Government Medical College Srinagar, Srinagar, JK India
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Rathod R, Chatterji S, Damodharan N, Patro SK. An Infected Third Branchial Pouch Cyst presenting with Acute Stridor in an Infant. Indian J Otolaryngol Head Neck Surg 2022; 74:2578-2581. [PMID: 36452605 PMCID: PMC9701947 DOI: 10.1007/s12070-020-02284-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/10/2020] [Indexed: 10/23/2022] Open
Abstract
Branchial pouch cysts clinically mimic deep neck space infection and misdiagnosis leads to surgical drainage which can complicate into a persistently draining sinus or fistula. We present a unique case of infected third branchial pouch cyst in an infant who presented with acute stridor and our experience in its management.
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Affiliation(s)
- Ramya Rathod
- Department of Otolaryngology and Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sujoy Chatterji
- Department of Otolaryngology and Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Niveditha Damodharan
- Department of Otolaryngology and Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sourabha K. Patro
- Department of Otolaryngology and Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Alsaeedi BS, Alrasheedi AR, Bhat IN. A complete second branchial fistula in a four years old child. Int J Surg Case Rep 2022; 97:107365. [PMID: 35839656 PMCID: PMC9403028 DOI: 10.1016/j.ijscr.2022.107365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/25/2022] [Accepted: 06/25/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Second branchial anomalies either cyst, sinus, or fistula are the top differential diagnosis of lateral neck masses or swelling in pediatrics age group. Yet, it is very rare for the branchial fistula to have two openings. CASE PRESENTATION Here we present a four years old child diagnosed with complete branchial fistula by CT scan with dye injection throughout the fistula tract. We successfully managed him by complete surgical resection. Also, we provide the current literature that aids in the diagnosis and treatment of complete second branchial fistula. CONCLUSION Complete second branchial fistula is not that common anomaly; however, we must consider it as a differential diagnosis in any lateral neck masses. Complete surgical resection, step ladder approach, which will minimise the recurrence rate is the treatment of choice.
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Khoury M, Dong SX, Alsaffar H, Johnson-Obaseki S, Caulley L. Isolated oropharyngeal abscess with hypopharyngeal extension recurring 12 years after initial surgical management: A case report and review of the literature. SAGE Open Med Case Rep 2022; 10:2050313X221089119. [PMID: 35401981 PMCID: PMC8984837 DOI: 10.1177/2050313x221089119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/04/2022] [Indexed: 11/17/2022] Open
Abstract
Pharyngeal abscesses require urgent management as they have the propensity to cause severe and life-threatening complications. The introduction of antibiotics has led to a dramatic decline in the incidence of these infections. Regardless, abscess formation continues to be observed in the peritonsillar, parapharyngeal, and retropharyngeal spaces. Oropharyngeal and hypopharyngeal abscesses that cause airway obstruction are scarcely reported and tend to be secondary to other processes. Herein, we describe the case of an 83-year-old man presenting with an idiopathic, obstructive, oropharyngeal wall abscess, extending from the infratonsillar region to the hypopharynx, which recurred after initial surgical management 12 years prior for the same process. He required reintervention during both episodes for rapid reaccumulation. A detailed electronic literature search of PubMed and MedLine was performed for studies reporting on recurrent pharyngeal abscesses and their management. Results were limited to articles published in English from inception to August 2021. The timely management of pharyngeal infections acutely obstructing the airway is crucial. Physicians should adopt close and frequent monitoring and have a low threshold for reimaging should symptoms worsen or fail to improve after the initial surgical intervention.
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Affiliation(s)
- Michel Khoury
- Department of Undergraduate Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Selina Xiangxu Dong
- Department of Undergraduate Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Hussain Alsaffar
- Department of Otolaryngology—Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Stephanie Johnson-Obaseki
- Department of Otolaryngology—Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Lisa Caulley
- Department of Otolaryngology—Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Knowledge Synthesis Group, Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
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A Retrospective Clinico-Pathological Analysis with Review of Literature of Oral and Cervical Lympho-Epithelial Cysts from a Pathological Perspective. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12052525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Oral and cervical lympho-epthelial cysts (LECs) are uncommon lesions with histopathological similarities. The aim of the study is to present clinico-pathological characteristics of oral and cervical LECs with a review of literature in order to create awareness on this uncommon entity. Eighteen new cases of oral and cervical LECs obtained from the archives of the University of Peradeniya and University of Geneva were used for the clinico-pathological analysis. The average age at diagnosis of 7 oral and 11 cervical LECs were 40 and 36 years, respectively. Both showed a female predilection (male:female ratio at 3:4 and 4:7, respectively). The only difference was found in the size of the lesions with oral LECs being significantly smaller than cervical LECs (0.9 cm vs. 4.6 cm). LECs may clinically resemble neoplasms (4/18), including malignancies (1/11 in the present series). None of the 18 LECs recurred following surgical removal. The literature-review-based analysis of 514 oral LECs confirms that the lesions are observed predominantly in adults in 4th–5th decades of life and are relatively small lesions of less than 2 cm in diameter. Oral LECs were found to occur predominantly in the tongue and floor of the mouth, similar to 88% of lesions in literature. In conclusion, oral and cervical LECs are two histologically similar cysts that occur in two distinct sites. The literature review supports the information observed in our study with respect to age of occurrence, site predilections, and size. Cervical LECs, particularly the ones that occur in the parotid region, may require further investigations to exclude BLEL of parotid gland, which occur in HIV infected patients.
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Jeong IS, Lee YS, Cho WK, Choi SH, Kim SY, Nam SY. Suture Ligation of Pyriform Sinus Fistulas Following Cauterization to Treat Branchial Cleft Anomalies. Ann Otol Rhinol Laryngol 2022; 131:1369-1374. [PMID: 35043664 DOI: 10.1177/00034894211070144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Obliteration with cauterization of the internal opening of pyriform sinus fistulas, with or without marsupialization, has been a mainstay for preventing recurrence. However, this procedure predisposes patients to recurrence caused by the reopening of the cauterized orifice. We applied suture ligation to secure the closure of the internal orifice following cauterization and evaluated treatment. METHODS A total of 42 patients were diagnosed with third or fourth branchial cleft anomaly with internal pyriform sinus fistula and treated either with cauterization or with cauterization and suture ligation, between January 2008 and December 2020. The medical records were reviewed to assess demographic characteristics, clinical presentations, diagnoses, surgical treatment, and outcomes. Treatment flow characteristics for intractable patients were analyzed. RESULTS The median age of onset was 9 years (range, 0-57 years). Neck swelling (n = 32, 76.2%) was commonly encountered symptom, and a history of neck infection was found in 27 patients (64.3%). After initial treatment, 11 cases (56.2%) recurred. Younger age (≤9 years) and thyroid involvement were associated with recurrence (P = .034 and P = .046, respectively). Cauterization with suture ligation presented lower recurrence rate (19.2%) than cauterization only (37.5%, P = .037). Cauterization with suture ligation for recurrent cases (n = 11) showed 81.8% (9/11) of cure rate. Intractable fistulas (n = 2) from both groups were also salvaged by suture ligation. CONCLUSIONS Suture ligation with cauterization for an internal orifice of branchial anomaly showed lower recurrence rate than cauterization only. This method was beneficial for refractory cases.
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Affiliation(s)
- In Seong Jeong
- Department of Otolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoon Se Lee
- Department of Otolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Ki Cho
- Department of Otolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Ho Choi
- Department of Otolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Yoon Kim
- Department of Otolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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12
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Neonatal respiratory distress due to a third or fourth branchial pouch sinus: A systematic review. Int J Pediatr Otorhinolaryngol 2021; 151:110922. [PMID: 34525447 DOI: 10.1016/j.ijporl.2021.110922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/20/2021] [Accepted: 09/06/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Third and fourth branchial pouch sinuses can be rare causes of respiratory distress in neonates. An overview of this distinct clinical entity is missing in literature. To aid clinicians in recognizing and adequately treating this unique entity, we conducted a systematic review to discuss patient characteristics, diagnostic considerations and treatment strategy. METHODS MEDLINE and EMBASE were searched from inception to December 29th, 2020. Original studies concerning patients with respiratory symptoms as a result of a third or fourth branchial pouch sinus, as confirmed with rigid endoscopy, videofluoroscopy or during surgery. RESULTS Thirty-nine studies describing 56 patients (66% male, aged 0-30 days) were analyzed. Symptoms included cervical mass (76.8%), stridor (55.4%), dyspnea (35.7%) and cyanosis (17.9%) due to a third (39.3%) or fourth (60.7%) branchial pouch sinus. Intubation was performed before treatment in 31.3%. The piriform sinus opening was identified with rigid endoscopy in 81.1%. Surgery was the treatment of choice in the majority of patients (85.7%), with a success rate of 100% and a complication rate of 10.7%. Endoscopic cauterization was successful in 40% and endoscopic cauterization followed by sclerotherapy was successful 100%, with no complications. CONCLUSION Third or fourth branchial pouch sinuses can lead to respiratory distress in neonates. It is important to recognize this distinct clinical picture for adequate diagnosis and treatment. Rigid endoscopy is indicated to demonstrate an opening in the piriform sinus and provides the opportunity to directly perform treatment with endoscopic cauterization. If this is insufficient to relief respiratory symptoms due to a persistent cyst, sclerotherapy or surgical excision should be considered.
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Hod R, Lachance S, Chadha NK. Endoscopic cauterisation and injection of Voicegel for treatment of congenital pyriform fossa sinus tracts. ACTA OTORHINOLARYNGOLOGICA ITALICA 2021; 41:432-435. [PMID: 34734578 PMCID: PMC8569664 DOI: 10.14639/0392-100x-n1433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/15/2021] [Indexed: 11/23/2022]
Abstract
Objective To demonstrate our experience in treating pyriform fossa sinus tracts (PFST) using a novel technique of endoscopic cauterisation of the pyriform fossa sinus opening combined with injection of sodium carboxymethylcellulose gel (VoiceGel) lateral to the tract to encourage tight closure. Methods Over a 48-month period, we used this technique on 11 patients who were diagnosed with PFST at BC Children's Hospital, a tertiary paediatric centre in Vancouver, BC, Canada. Results The 11 patients included 8 males and 3 females, and mean age at presentation was 69 months (range 22-108 months). Mean time from beginning of symptoms till diagnosis was 15 months (range 12-22 months). Ten PFST were on the left side of the neck and one on the right. Nine patients presented with recurrent neck infections and two had suppurative thyroiditis. All patients had endoscopic cauterisation of their PFST opening combined with injection of carboxymethylcellulose lateral to the sinus tract to cause tract collapse. Mean follow up was 15.8 months (range 8-24). All patients are asymptomatic without recurrence at the last follow-up visit. No post-operative complications were reported. Conclusions Endoscopic management of paediatric PFST combined with the injection of sodium carboxymethylcellulose gel lateral to the sinus tract appears to be a safe and effective treatment option for PFST.
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Affiliation(s)
- Roy Hod
- Department of Pediatric Otolaryngology, Schneider Children's Medical Center of Israel, Petach Tiqwa, Israel.,Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Sophie Lachance
- Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada.,Département d'Oto-rhino-laryngologie et chirurgie cervico-faciale, CHUL, CHU de Québec, Québec, Canada
| | - Neil K Chadha
- Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
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Huysseune A, Cerny R, Witten PE. The conundrum of pharyngeal teeth origin: the role of germ layers, pouches, and gill slits. Biol Rev Camb Philos Soc 2021; 97:414-447. [PMID: 34647411 PMCID: PMC9293187 DOI: 10.1111/brv.12805] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/15/2022]
Abstract
There are several competing hypotheses on tooth origins, with discussions eventually settling in favour of an 'outside-in' scenario, in which internal odontodes (teeth) derived from external odontodes (skin denticles) in jawless vertebrates. The evolution of oral teeth from skin denticles can be intuitively understood from their location at the mouth entrance. However, the basal condition for jawed vertebrates is arguably to possess teeth distributed throughout the oropharynx (i.e. oral and pharyngeal teeth). As skin denticle development requires the presence of ectoderm-derived epithelium and of mesenchyme, it remains to be answered how odontode-forming skin epithelium, or its competence, were 'transferred' deep into the endoderm-covered oropharynx. The 'modified outside-in' hypothesis for tooth origins proposed that this transfer was accomplished through displacement of odontogenic epithelium, that is ectoderm, not only through the mouth, but also via any opening (e.g. gill slits) that connects the ectoderm to the epithelial lining of the pharynx (endoderm). This review explores from an evolutionary and from a developmental perspective whether ectoderm plays a role in (pharyngeal) tooth and denticle formation. Historic and recent studies on tooth development show that the odontogenic epithelium (enamel organ) of oral or pharyngeal teeth can be of ectodermal, endodermal, or of mixed ecto-endodermal origin. Comprehensive data are, however, only available for a few taxa. Interestingly, in these taxa, the enamel organ always develops from the basal layer of a stratified epithelium that is at least bilayered. In zebrafish, a miniaturised teleost that only retains pharyngeal teeth, an epithelial surface layer with ectoderm-like characters is required to initiate the formation of an enamel organ from the basal, endodermal epithelium. In urodele amphibians, the bilayered epithelium is endodermal, but the surface layer acquires ectodermal characters, here termed 'epidermalised endoderm'. Furthermore, ectoderm-endoderm contacts at pouch-cleft boundaries (i.e. the prospective gill slits) are important for pharyngeal tooth initiation, even if the influx of ectoderm via these routes is limited. A balance between sonic hedgehog and retinoic acid signalling could operate to assign tooth-initiating competence to the endoderm at the level of any particular pouch. In summary, three characters are identified as being required for pharyngeal tooth formation: (i) pouch-cleft contact, (ii) a stratified epithelium, of which (iii) the apical layer adopts ectodermal features. These characters delimit the area in which teeth can form, yet cannot alone explain the distribution of teeth over the different pharyngeal arches. The review concludes with a hypothetical evolutionary scenario regarding the persisting influence of ectoderm on pharyngeal tooth formation. Studies on basal osteichthyans with less-specialised types of early embryonic development will provide a crucial test for the potential role of ectoderm in pharyngeal tooth formation and for the 'modified outside-in' hypothesis of tooth origins.
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Affiliation(s)
- Ann Huysseune
- Research Group Evolutionary Developmental Biology, Biology Department, Ghent University, K.L. Ledeganckstraat 35, Ghent, B-9000, Belgium
| | - Robert Cerny
- Department of Zoology, Faculty of Science, Charles University, Vinicna 7, Prague, 128 44, Czech Republic
| | - P Eckhard Witten
- Research Group Evolutionary Developmental Biology, Biology Department, Ghent University, K.L. Ledeganckstraat 35, Ghent, B-9000, Belgium
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Li Y, Mashhood A, Mamlouk MD, Lindan CE, Feldstein VA, Glenn OA. Prenatal Diagnosis of Third and Fourth Branchial Apparatus Anomalies: Case Series and Comparison with Lymphatic Malformation. AJNR Am J Neuroradiol 2021; 42:2094-2100. [PMID: 34620588 DOI: 10.3174/ajnr.a7293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/19/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Third and fourth branchial apparatus anomalies are rare congenital anomalies. The purpose of this study was to investigate imaging features of these lesions on fetal MR imaging in comparison with lymphatic malformations, the major competing differential diagnosis in these cases. MATERIALS AND METHODS A retrospective review of our institutional fetal MR imaging database between 1997 and 2019 resulted in 4 patients with confirmed third and fourth branchial apparatus anomalies and 14 patients with confirmed lymphatic malformations. The imaging features were reviewed by consensus, and the Fisher exact test was used to evaluate statistically significant differences between these 2 populations. RESULTS Four cases of third and fourth branchial apparatus anomalies were imaged at 29 weeks 1 day (range, 23 weeks 1 day to 33 weeks 4 days). All 4 cases demonstrated unilateral, unilocular cysts without reduced diffusion or hemorrhage and a medially directed beaked contour that tapered between the spine and airway at the level of the piriform sinus. Compared with 14 cases of fetal lymphatic malformations imaged at 27 weeks 6 days (range, 21 weeks 3 days to 34 weeks 6 days), third and fourth branchial apparatus cysts were significantly more likely to be unilocular (P < .005) and to have a medially beaked contour (P < .005). The combination of features of unilateral, unilocular, and medially beaked contour was observed only in the fetuses with third and fourth branchial apparatus cysts (P < .001). CONCLUSIONS The presence of a left-sided unilocular cyst with a medially beaked contour tapering at the level of the piriform sinus suggests the diagnosis of third and fourth branchial apparatus anomaly. Accurate diagnosis in the prenatal period allows proper counseling, genetic work-up, and treatment, potentially sparing patients from recurrent infections and associated morbidity.
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Affiliation(s)
- Y Li
- From the Department of Radiology and Biomedical Imaging (Y.L., C.E.L., V.A.F., O.A.G.), Neuroradiology Section, University of California San Francisco, San Francisco, California
| | - A Mashhood
- Palo Alto Veteran Affairs Medical Center (A.M.), Stanford University, Palo Alto, California
| | - M D Mamlouk
- The Permanente Medical Group (M.D.M.), Kaiser Permanente Medical Center Santa Clara, Santa Clara, California
| | - C E Lindan
- From the Department of Radiology and Biomedical Imaging (Y.L., C.E.L., V.A.F., O.A.G.), Neuroradiology Section, University of California San Francisco, San Francisco, California
| | - V A Feldstein
- From the Department of Radiology and Biomedical Imaging (Y.L., C.E.L., V.A.F., O.A.G.), Neuroradiology Section, University of California San Francisco, San Francisco, California
| | - O A Glenn
- From the Department of Radiology and Biomedical Imaging (Y.L., C.E.L., V.A.F., O.A.G.), Neuroradiology Section, University of California San Francisco, San Francisco, California
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16
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Yang R, Dong C, Chen Y, Liu H, Zhang C, Lai Y, Zha D, Han Y. Analysis of the Clinical Features and Surgical Outcomes of First Branchial Cleft Anomalies. Laryngoscope 2021; 132:1008-1014. [PMID: 34617600 DOI: 10.1002/lary.29896] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/17/2021] [Accepted: 09/28/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To analyze the clinical features and otologic manifestations of first branchial cleft anomalies (FBCAs) and the disparity between Work's classification, and to explore the relationships between postoperative facial paralysis and features of FBCAs. STUDY DESIGN Retrospective clinical study. METHODS A retrospective analysis of 109 patients with FBCAs was conducted, including clinical characteristics and otologic features. Pearson chi-square tests and Fisher's exact tests were used to compare disparity between Work's classification, and the impact factors of postoperative facial paralysis among 86 patients who were explored in follow-up. RESULTS Patients with FBCAs presented with otologic symptoms, including cysts or fistula in the external auditory canal (EAC) and periauricular (43.2%), microtia (3.7%), EAC web (1.8%), otitis media (1.8%), and otorrhea (4.6%). Eighty-five cases (78.0%) were type I FBCAs and 24 (22.0%) were type II. Compared to type I FBCAs, type II (58.3%) was more likely to be located deep to the facial nerve (FN) and to have superficial parotidectomy on them (79.2%). This difference was statistically significant (P < .001). FBCAs deep to the FN had a higher incidence of postoperative facial paralysis (P < .05). CONCLUSION The majority of patients (55.0%) had otologic symptoms. The FBCAs of Work type II was commonly deep to the FN and superficial parotidectomy was frequently performed. Postoperative facial paralysis was associated with FBCAs located deep to the FN, but not with Work's type. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Runqin Yang
- Department of Otolaryngology-Head and Neck Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Chen Dong
- Department of Otolaryngology-Head and Neck Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Yang Chen
- Department of Otolaryngology-Head and Neck Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Hongsheng Liu
- Department of Radiology, Xi'an Central Hospital, Xi'an, China
| | - Changming Zhang
- Department of Otolaryngology-Head and Neck Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Yubin Lai
- Department of Otolaryngology-Head and Neck Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | | | - Yu Han
- Department of Otolaryngology-Head and Neck Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China
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Meijers S, Meijers R, van der Veen E, van den Aardweg M, Bruijnzeel H. A Systematic Literature Review to Compare Clinical Outcomes of Different Surgical Techniques for Second Branchial Cyst Removal. Ann Otol Rhinol Laryngol 2021; 131:435-444. [PMID: 34137276 PMCID: PMC8899809 DOI: 10.1177/00034894211024049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objective: During the last 2 decades, new treatment methods have been developed for the
surgical removal of second branchial cysts which result in less visible
scars. The aim of this systematic review is to assess which surgical
technique for second branchial arch cyst removal results in the lowest
complication and recurrence rates with the highest scar satisfaction. Methods: Two authors systematically reviewed the literature in the Cochrane, PubMed,
and EMBASE databases (search date: 1975 to December 2nd, 2020) to identify
studies comparing surgical outcomes of second branchial arch cyst removal.
Authors appraised selected studies on directness of evidence and risk of
bias. Results are reported according to Preferred Reporting Items for
Systematic Reviews and Meta-Analyses statement. Results: Out of the 2442 retrieved articles, 4 articles were included in the current
review including a total of 140 operated cysts. Only 2 studies included
pre-operatively infected cysts. Follow up ranged from 3 to 24 months.
Complication rates ranged from 0 to 27.3% (conventional: [0–10.4%];
endoscopic/retro-auricular: [0–27.3%]). None of the patients presented with
postoperative recurrence. Significantly higher scar satisfaction was found
in adult patients who underwent endoscopic or retro-auricular hairline
incision cyst removal. Conclusion: No recurrence of disease occurred during (at least) 3 months of follow up
using either conventional surgery or endoscopic/retro-auricular techniques.
Although more (temporary) complications occur using endoscopic and
retro-auricular techniques, patients report a significantly higher scar
satisfaction 3 to 6 months after surgery in comparison to the conventional
technique. Future studies are needed to support these findings.
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Affiliation(s)
- Sebastiaan Meijers
- Department of Otorhinolaryngology and
Head and Neck Surgery, University Medical Center Utrecht, the Netherlands
| | - Rutger Meijers
- Department of Neurology, Radboud
University Medical Center, Nijmegen, The Netherlands
| | - Erwin van der Veen
- Department of Otorhinolaryngology and
Head and Neck Surgery, University Medical Center Utrecht, the Netherlands
- Central Military Hospital, Utrecht, The
Netherlands
| | - Maaike van den Aardweg
- Department of Otorhinolaryngology and
Head and Neck Surgery, Rivierenland Hospital, Tiel, The Netherlands
| | - Hanneke Bruijnzeel
- Department of Otorhinolaryngology and
Head and Neck Surgery, University Medical Center Utrecht, the Netherlands
- Brain Center Rudolf Magnus, Utrecht,
The Netherlands
- Hanneke Bruijnzeel, MD, PhD, Department of
Otolaryngology and Head and Neck Surgery, Utrecht Medical Center, Heidelberglaan
100, Utrecht 3584 CX, The Netherlands.
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18
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Li WX, Dong Y, Zhang A, Tian J, Lu C, Jeannon JP, Liu L. Surgical treatment of fourth branchial apparatus anomalies: a case series study. J Otolaryngol Head Neck Surg 2020; 49:79. [PMID: 33198806 PMCID: PMC7670670 DOI: 10.1186/s40463-020-00477-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/02/2020] [Indexed: 11/17/2022] Open
Abstract
Background Fourth branchial apparatus anomalies, are rare clinical entities, and present as complex cysts, sinuses and fistulae in the neck that can be difficult to manage. Methods This is a retrospective review of a series of consecutive patients with fourth branchial apparatus anomalies treated at Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, from Apr 2014 to Nov 2019. Results Ten patients with fourth branchial apparatus anomalies were identified, including 8 patients with fourth branchial fistula, and 2 patients with fourth branchial pouch sinus. There were 6 female patients and 4 male patients. Their age was from 6 years old to 39 years old (average age 20.4 years old, median age was 21 years old). All 8 fistulae were on the left side, while 2 pouch sinuses were both on the right side. Pre-operative examination with fiberoptic laryngoscope, barium swallow X-ray, CT or MRI identified internal orifice at pyriform fossa apex in 8 (80%) patients. All patients underwent challenging surgical resection by the senior author. Intra-operative direct laryngoscope confirmed or identified internal orifice in 9 (90%) patients. The tracts were all followed to the vicinity of inferior cornu of the thyroid cartilage and the cricothyroid space. Complete resection of cervical lesions and their attachment to hypopharynx were achieved in 9 cases. No complication occurred. One recurrence was detected, in the only patient whose internal orifice could not be located pre- or intra-operatively, and the hypopharyngeal attachment could not be removed. Conclusions Direct laryngoscopy under general anesthesia is a reliable method of diagnosis for the fourth branchial apparatus anomalies. Complete surgical removal of fourth branchial apparatus anomalies, including their hypopharyngeal attachment, is the treatment of choice, and the key to prevent recurrence.
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Affiliation(s)
- Wan-Xin Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, 95th Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Yanbo Dong
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, 95th Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Aobo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, 95th Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Jun Tian
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, 95th Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Cheng Lu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, 95th Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Jean Pierre Jeannon
- Surgical Oncology, Guy's & St Thomas NHS Hospital, Kings College London, London, UK
| | - Liangfa Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, 95th Yong'an Road, Xicheng District, Beijing, 100050, China.
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19
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Maksimoski M, Maurrasse SE, Purkey M, Maddalozzo J. Combination Surgical Procedure for Fourth Branchial Anomalies: Operative Technique and Outcomes. Ann Otol Rhinol Laryngol 2020; 130:738-744. [PMID: 33158383 DOI: 10.1177/0003489420971674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Branchial apparatus anomalies of the fourth cleft are the rarest subtype of anomaly and occasionally present with suppurative thyroiditis or thyroid abscess due to their relationship with the thyroid gland. Surgical approaches vary and some surgeons favor cauterization of associated pyriform sinus tracts alone versus complete surgical excision. Currently, the literature is scarce and there is limited data on surgical outcomes and procedural steps. Here we describe a combination surgical technique for fourth branchial anomalies including: (1) surgical excision of the cyst and any external pit, (2) hemithyroidectomy, and (3) direct laryngoscopy with cauterization of pyriform apex tract, if present. METHODS A retrospective review was performed on all patients who underwent surgical excision of fourth branchial apparatus lesions (including fistulae, cysts, and sinus tracts) at an urban pediatric university hospital from 2000 to 2019. Data regarding demographics, medical history, surgical methods, complications, and surgical cure rates were collected. RESULTS A total of 16 patients (9 female, 7 male) underwent a combination surgical procedure for fourth branchial apparatus lesions. Success rate after primary surgery was 94%. One patient had residual disease requiring re-operation. Two patients had post-operative complications: 1 transient vocal fold paresis and 1 seroma, both managed conservatively. A consensus surgical algorithm was created based on operative steps present in the majority of cases. CONCLUSION A combination approach to fourth branchial apparatus lesions-including endoscopic cauterization, external excision, and hemithyroidectomy-is safe and provides a high rate of primary cure. Although less invasive options exist, remnants of the branchial lesion, especially in the thyroid, may remain and cause recurrent issues. Therefore, we advocate for complete surgical excision of this rare developmental anomaly, especially when obvious thyroid involvement exists.
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Affiliation(s)
- Matthew Maksimoski
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sarah E Maurrasse
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Matthew Purkey
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John Maddalozzo
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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20
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Sakakura K, Yasuoka Y, Shino M, Toyoda M, Obi K, Chikamatsu K. Two Different Tracts and Origin of Pyriform Sinus Fistula. Ann Otol Rhinol Laryngol 2020; 130:629-635. [PMID: 33084367 DOI: 10.1177/0003489420966348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Suppurative acute thyroiditis is caused by pyriform sinus fistula (PSF), and PSF frequently elicits deep neck abscess. However, complete fistulectomy is the ideal management of PSF, and studies on surgical findings of PSF are exceedingly rare. This study aimed to reveal the origins of PSF, each route, and clinical presentation. METHODS This is a multicenter study. We have conducted 19 complete fistulectomies of PSF in Japan, analyzed routes of the fistulas, estimated the origins, and investigated their histological and clinical findings. RESULTS No recurrence was observed in all cases. Five of 12 cases showed thymic and/or parathyroid tissues around the fistulas, passing inside the inferior horn of thyroid cartilage, were regarded as having 3rd pouch origin, and tended to have low frequency of severe deep neck abscess. The remaining 7 cases originated from the 4th pouch running outside of the horn and showed frequent severe infection. CONCLUSION PSF have 2 different routes depending on their generation and may present different clinical manifestations.
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Affiliation(s)
- Koichi Sakakura
- Department of Otolaryngology-Head and Neck Surgery, Gunma University Graduate School of Medicine
| | - Yoshihito Yasuoka
- Department of Otolaryngology-Head and Neck Surgery, Gunma University Graduate School of Medicine
| | - Masato Shino
- Department of Otolaryngology-Head and Neck Surgery, Gunma University Graduate School of Medicine
| | - Minoru Toyoda
- Department of Otolaryngology-Head and Neck Surgery, Gunma University Graduate School of Medicine
| | - Kisho Obi
- Department of Otolaryngology-Head and Neck Surgery, Gunma University Graduate School of Medicine
| | - Kazuaki Chikamatsu
- Department of Otolaryngology-Head and Neck Surgery, Gunma University Graduate School of Medicine
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21
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Muranishi Y, Nishimoto S, Kawai K, Ishise H, Kakibuchi M. An occult case of the first branchial cleft anomaly. J Surg Case Rep 2020; 2020:rjaa291. [PMID: 32939241 PMCID: PMC7482978 DOI: 10.1093/jscr/rjaa291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 12/16/2022] Open
Abstract
We report a case of the first branchial cleft anomaly, clinically typical but occult in images and pathology. An 8-year-old female who had an induration below her right mandibular angle was referred to our department with a diagnosis of an infectious epidermal cyst. CT and MRI had shown no evidence of fistula or cyst. At the initial operation, a string structure was observed, but pathologically no epithelial structure was observed. However, the infection at the same site repeated and the symptoms became more severe than before. Considering a high probability of the first branchial anomaly, partial parotidectomy was performed as radical surgery. A cord structure attached to subcutaneous tissue at the intertragal notch was found. Although no epithelial component in the pathology was detected, this string structure was clinically considered as the rudimentary form of the first branchial anomaly.
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Affiliation(s)
- Yumi Muranishi
- Department of Plastic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, Japan
| | - Soh Nishimoto
- Department of Plastic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, Japan
| | - Kenichiro Kawai
- Department of Plastic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, Japan
| | - Hisako Ishise
- Department of Plastic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, Japan
| | - Masao Kakibuchi
- Department of Plastic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, Japan
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22
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Yunaiyama D. Editorial for "MRI in Children With Pyriform Sinus Fistula". J Magn Reson Imaging 2020; 53:96-97. [PMID: 32798242 DOI: 10.1002/jmri.27323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/08/2022] Open
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Second branchial cleft fistula/sinus tract endoscopy: a novel intraoperative technique assisting complete surgical resection. Eur Arch Otorhinolaryngol 2020; 278:833-838. [PMID: 32601920 DOI: 10.1007/s00405-020-06158-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/18/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE Second branchial cleft (BC) sinus/fistula anomalies usually present in children. Their definitive management requires complete tract surgical excision, which necessities accurate extension assessment. Our aim is to propose and describe a novel intraoperative endoscopic technique that can help in evaluating the exact BC anomaly tract extension and overcome disadvantages of currently used methods including imaging and intraoperative methylene blue tract injection. METHODS The innovative intraoperative endoscopic technique involves performing BC sinus/fistula tract intraluminal endoscopy utilizing miniature 1.3 or 1.6 mm all-in-one semi-rigid endoscopes as well as other accessory equipment currently available and used for sialendoscopy for delineation of exact tract extension followed by a complete standard surgical excision tailored to and assisted by the endoscopic procedure. RESULTS This novel endoscopic technique was used successfully in five children (age range 8-16 years) presenting with unilateral or bilateral congenital second BC discharging fistula/sinus tracts in the neck. Intraoperative endoscopic assessment took 10-15 min and confirmed the exact tract extension and nature in all patients without complications. Five fistulas and two sinuses were identified and completely surgically resected. No recurrence has been observed after a median follow-up of 29 (range 13-45) months. CONCLUSION Intraoperative second BC fistula/sinus tract endoscopy could help in accurately assessing anomaly extension, thereby assisting in complete surgical excision. This innovative novel endoscopic technique could avoid disadvantages of currently used methods, especially regarding radiation exposure required for imaging children in whom this anomaly usually presents.
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Moroco AE, Saadi RA, Patel VA, Lehman EB, Wilson MN. Postoperative Outcomes of Branchial Cleft Cyst Excision in Children and Adults: An NSQIP Analysis. Otolaryngol Head Neck Surg 2020; 162:959-968. [PMID: 32484763 DOI: 10.1177/0194599820915468] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Identify risk factors and perioperative morbidity for patients undergoing branchial cleft cyst (BCC) excision. STUDY DESIGN Cross-sectional analysis. SETTING American College of Surgeons National Surgical Quality Improvement Program adult and pediatric databases (NSQIP and NSQIP-P). SUBJECT AND METHODS Patients who underwent BCC excision (Current Procedural Terminology 42810, 42815) were queried via NSQIP (2005-2016) and NSQIP-P (2012-2016). Outcomes analyzed include patient demographics, medical comorbidities, admission type, operative characteristics, length of hospital stay, postoperative complications, and readmission. RESULTS A total of 1775 children and 677 adults were identified. Mean age at time of surgery was 4.6 years for children and 38.6 years for adults. Outpatient procedures were performed in 87.1% of adults and 94.0% of children (P < .001). Postoperative complications were uncommon, occurring in <1% of adults and 3.9% of children (P < .001). Similarly, readmission occurred in 1.2% of adults and 1.1% of children. In adults, smoking status was shown to have a significant effect on postoperative complications (odds ratio, 6.25; P = .037). Age group did not have an effect on the complication rate in the pediatric population. Pediatric otolaryngologists had higher rates of postoperative complications (P = .001), prolonged operative times (P < .001), and fewer outpatient procedures (P < .001). Conversely, in adults, otolaryngologists had fewer postoperative complications. CONCLUSION Postoperative complications following BCC excision are relatively uncommon, demonstrating procedural safety when performed at any age.
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Affiliation(s)
- Annie E Moroco
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Robert A Saadi
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Vijay A Patel
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Erik B Lehman
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Meghan N Wilson
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
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Lhamu U, Wassner AJ, Topor LS. COINCIDENT SUPPURATIVE THYROIDITIS AND GRAVES DISEASE IN A PATIENT WITH INFECTED BRANCHIAL CLEFT CYST. AACE Clin Case Rep 2020; 5:e365-e368. [PMID: 31967072 DOI: 10.4158/accr-2019-0236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/17/2019] [Indexed: 11/15/2022] Open
Abstract
Objective Acute suppurative thyroiditis (AST) is frequently caused by anatomic abnormalities, including branchial cleft cysts. Patients with AST are typically euthyroid, but thyrotoxicosis may occur. Thyroid antibodies are usually not present in AST. Our objective is to describe a teenage male who presented with concomitant suppurative thyroiditis and Graves disease (GD). Methods We report a case of an infected left branchial cleft cyst with AST and concurrent GD in an adolescent male. Thyroid function tests and thyroid imaging were used for diagnostic evaluation, and the patient was managed with antibiotics, analgesia, and surgery. Results A 17-year-old male with a history of an infected left fourth branchial cleft cyst presented with recurrence of neck pain, odynophagia, and fever. Serum labs showed thyrotoxicosis and elevated thyroid antibodies and inflammatory markers. Magnetic resonance imaging showed an abscess adjacent to the left thyroid lobe. Symptoms resolved after antibiotic therapy, but laboratory tests showed persistent subclinical thyrotoxicosis. Four months later, he underwent excision of the branchial cleft cyst and left thyroid lobe. Two months after surgery, evaluation showed overt thyrotoxicosis with laboratory tests confirming GD. Methimazole was initiated and thyroid function subsequently normalized. Conclusion This patient manifested a rare coincidence of AST due to a branchial cleft cyst and autoimmune thyroid disease. Further studies are needed to determine if there is any relationship between AST and development of thyroid autoimmunity. Assessment of thyroid autoimmunity may be considered in patients with prior or recurrent AST.
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Goh LC, Norain RS, Shifa Z, Manuel AM. Bilateral Second Arch Branchial Fistula-A Case Report. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2019; 31:383-386. [PMID: 31857983 PMCID: PMC6914326 DOI: 10.22038/ijorl.2019.35910.2186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction: Branchial arch anomalies represent defects in embryological developments whereby parts of the branchial arch persist in the head and neck regions as sinuses, fistulas, or cysts. These anomalies usually present as a unilateral lesion in the head and neck of young adults and children, which are excised upon the emergence of complications. Case Report: Herein, we presented a rare case of a 4-year-old child, who had been diagnosed with a complete bilateral second arch branchial fistula. The excision was made using the bilateral stepladder approach and tonsillectomy. Conclusion: The bilateral stepladder approach was a feasible method in excising a complete bilateral branchial fistula. However, larger-scale studies should be conducted on the surgical techniques of bilateral branchial fistulae excision in order to optimize the cosmetic outcome of the surgery.
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Affiliation(s)
- Liang-Chye Goh
- Department of Otorhinolaryngology, University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Roslim-Siti Norain
- Department of Otorhinolaryngology, University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Zulkifli Shifa
- Department of Otorhinolaryngology, Hospial Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
| | - Anura-Michelle Manuel
- Department of Otorhinolaryngology, University of Malaya Medical Center, Kuala Lumpur, Malaysia
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Veugen CC, Blom HM. A two-year-old with a duplicated external auditory canal; a first branchial cleft anomaly. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2019. [DOI: 10.1080/23772484.2019.1698957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
| | - Henk M. Blom
- Department of Otorhinolaryngology, HagaZiekenhuis, The Hague, the Netherlands
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Ding XQ, Zhu X, Li L, Feng X, Huang ZC. Resection of recurrent third branchial cleft fistulas assisted by flexible pharyngotomy. World J Clin Cases 2019; 7:3957-3963. [PMID: 31832397 PMCID: PMC6906575 DOI: 10.12998/wjcc.v7.i23.3957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/29/2019] [Accepted: 11/15/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Treatment of fistulas arising from the third branchial cleft includes endoscopic cauterization or open cervical fistulectomy. Both approaches are associated with recurrence rates of 14%-18%, and possibly greater rates when the fistula has been treated operatively beforehand. Treatment of fistulas arising from the third branchial cleft is associated with an inordinate recurrence rate. Recurrence may be multifactorial and related to incomplete resection of all of the anatomical elements of the fistula.
AIM To present a new approach that involves complete resection of the recurrent fistula by a combined therapeutic approach.
METHODS Here, 12 adult patients diagnosed with recurrent third branchial cleft fistulas underwent a combined therapy assisted by flexible fiber-optic pharyngoscopy to identify and resect the entry site of the fistula into the pyriform sinus. The fistulous opening into the pyriform sinus was identified by flexible fiber-optic pharyngoscopy. The application of intubation with a guidewire by pharyngoscopy, in addition to the removal of the partial excision of the thyroid cartilage, allowed complete resection of the opening and all parts of the fistula tract.
RESULTS All of the internal openings of the fistulas in the pharynx were found and easily identified by flexible fiber-optic pharyngoscopy. All of the 12 patients underwent complete resection of the recurrent fistula by the combined therapeutic approach. There were no postoperative complications such as parapharyngeal abscess or wound infection, injury or dysfunction of the recurrent laryngeal or superior laryngeal nerves. The pharyngeal edema had degraded, and the pharyngeal wound healed postoperatively within 1 wk. Laryngeal endoscopy and voice analysis were performed on the 14th d post-operatively. Vocal cord movements did not change. The characters of voice for jitter, shimmer, and normalized noise energy were all within normal limits. In addition, no recurrences were observed during the 13-60 mo follow-up period.
CONCLUSION It can be concluded that the proposed combined therapy is associated with excellent results, minimal morbidity, and no recurrence.
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Affiliation(s)
- Xiao-Qiong Ding
- Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital Southeast University, Nanjing 210000, Jiangsu Province, China
| | - Xin Zhu
- Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital Southeast University, Nanjing 210000, Jiangsu Province, China
| | - Ling Li
- Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital Southeast University, Nanjing 210000, Jiangsu Province, China
| | - Xu Feng
- Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital Southeast University, Nanjing 210000, Jiangsu Province, China
| | - Zhi-Chun Huang
- Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital Southeast University, Nanjing 210000, Jiangsu Province, China
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Hosokawa T, Takahashi H, Miyasaka Y, Ohira K, Tanami Y, Sato Y, Ishimaru T, Kawashima H, Hosokawa M, Oguma E, Yamada Y. Ultrasound Evaluation of Dermal Sinuses/Fistulas in Pediatric Patients. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3107-3122. [PMID: 31063247 DOI: 10.1002/jum.15016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/01/2019] [Accepted: 04/10/2019] [Indexed: 06/09/2023]
Abstract
A dermal sinus/fistula is a common condition; the relevant department should be consulted for appropriate treatment. It is important for radiologists to have adequate knowledge of these conditions to provide the correct diagnosis and recommend subsequent management. This review describes the following lesions: preauricular sinus, midline sinus of the upper lip, nasal dermoid sinus cyst, cheek fistula, first branchial cleft anomaly/sublingual branchial cleft anomaly, thyroglossal duct cyst/fistula, lateral cervical sinus/fistula, congenital dermal sinus/fistula of the anterior chest region, congenital skin sinus/fistula with a sternal cleft, and congenital prepubic sinus. On the basis of the skin orifice location and ultrasound images, radiologists can provide useful information to physicians.
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Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroaki Takahashi
- Department of Diagnostic and Interventional Radiology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yusuke Miyasaka
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Kenji Ohira
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Tetsuya Ishimaru
- Department of Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kawashima
- Department of Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Mayumi Hosokawa
- Department of Pediatrics, Saitama City Hospital, Saitama, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
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Teng Y, Huang S, Chen G, Xian Z, Han S, Li L. Congenital pyriform sinus fistula presenting as a neck abscess in a newborn: A case report. Medicine (Baltimore) 2019; 98:e17784. [PMID: 31689849 PMCID: PMC6946197 DOI: 10.1097/md.0000000000017784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 09/17/2019] [Accepted: 10/03/2019] [Indexed: 12/02/2022] Open
Abstract
RATIONALE Congenital pyriform sinus fistula (CPSF) is a branchial abnormality originating from the third or fourth branchial pouch and is an important cause of anterior cervical abscess in children. Here we present a case of neck abscess in a newborn that was diagnosed as CPSF. PATIENT CONCERNS A male infant with a birth weight of 3660 g was admitted to hospital 25 minutes after birth after discovery of a cystic mass with extensive skin swelling in the left side of the neck. B-mode ultrasonography of the left neck showed an anterior cervical cystic mass of indeterminate nature. DIAGNOSIS Congenital pyriform sinus fistula. INTERVENTIONS The neck abscess was incised and drained under general anesthesia. Examination under suspension laryngoscopy revealed a pyriform sinus fistula. Laser cauterization was performed simultaneously. The wound was dressed and anti-inflammatory treatment was provided. OUTCOMES The neck wound healed uneventfully. After 3 months, the fistula was confirmed to be closed by laryngoscopy under general anesthesia. No recurrence was detected during 9 months of follow-up. LESSONS CPSF should be strongly suspected in a patient with an unexplained neck abscess or recurrent acute suppurative thyroiditis, especially on the left side.
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Sumana B, Sahaja K, Kalyani B, Swarupa K, Rao VRK. Branchial Cyst with Branchial Fistula: A Rare Association. Indian J Otolaryngol Head Neck Surg 2019; 71:633-636. [DOI: 10.1007/s12070-018-1443-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022] Open
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Swetha K, Nair S, Brijith KVR, Aishwarya JG, Nagamani YS, Indeewar H. Selective Neck Dissection Technique in the Treatment of Recurrent Pyriform Sinus Fistula. Indian J Otolaryngol Head Neck Surg 2019; 71:506-509. [DOI: 10.1007/s12070-018-1374-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022] Open
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Hirshoren N, Fried N, Weinberger JM, Eliashar R, Korem M. The Microbiology Characteristics of Infected Branchial Cleft Anomalies. OTO Open 2019; 3:2473974X19861065. [PMID: 31428729 PMCID: PMC6684145 DOI: 10.1177/2473974x19861065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/12/2019] [Indexed: 11/16/2022] Open
Abstract
Objectives To investigate the microbiology profile of infected branchial cleft anomalies compared to deep neck infection and explore the influence of age on culture findings. Study Design A retrospective case control study. Setting A single tertiary medical center. Subjects and Methods Patients treated for branchial cleft anomalies between 2006 and 2016 were included. Demographic data, disease and treatment parameters, and microbiology profile, including bacteria classification, antibiotics resistance patterns, and number of pathogens, were analyzed. Results Of 278 cases treated for branchial cleft anomalies, we have analyzed 69 cases with infection and pathogen identification. The proportion of monobacterial infections was higher (70.6% vs 44.3%; P = .003; odds ratio [OR], 3.02) and the proportion of Streptococcus species infection was lower (48.9% vs 77.2%; P = .001; OR, 0.282) among the infected branchial cleft cases compared to deep neck infections. Anaerobic bacteria infection did not differ between groups (17.8% and 16.5%, respectively). There was a nonsignificant tendency toward more resistant bacterial strains among the infected branchial clefts (15.6% vs 6.3%; P = .118; OR, 2.726). There was no difference between the bacterial profile of patients younger or older than 16 years. Conclusions The microbiology profile of infected branchial cleft anomalies is not age related and is different from that of deep neck infections. We demonstrate a relatively high frequency of monobacterial infections, relatively lower streptococcal infection rates, and a substantial contribution by resistant species and anaerobes. Empiric antibiotic treatment should cover Streptococcus species, including penicillin-resistant species, as well as clindamycin-resistant anaerobes.
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Affiliation(s)
- Nir Hirshoren
- Department of Otolaryngology/Head & Neck Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Neta Fried
- Department of Otolaryngology/Head & Neck Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Jeffrey M Weinberger
- Department of Otolaryngology/Head & Neck Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ron Eliashar
- Department of Otolaryngology/Head & Neck Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Maya Korem
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Liu Z, Mohd Slim MA, Jackson C, Trimble K. Spontaneous closure of branchial sinus of the pyriform fossa. BMJ Case Rep 2018; 2018:bcr-2017-223691. [PMID: 29764823 DOI: 10.1136/bcr-2017-223691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Management of third and fourth branchial cleft anomalies are similar. These anomalies should be suspected in a child with recurrent low-anterior neck abscess. Investigations in the form of cross-sectional studies and examination of the pharynx under anaesthesia will facilitate diagnosis and resolution of abscess. Spontaneous closure of the pyriform sinus can occur following conservative management with antibiotic treatment and abscess drainage. This emphasise the role of second-look prior to implementing endoscopic cauterisation or surgery.
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Affiliation(s)
- Zhaobo Liu
- Royal Belfast Hospital for Sick Children, Belfast, UK
| | | | - Conor Jackson
- Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Keith Trimble
- Royal Belfast Hospital for Sick Children, Belfast, UK
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A Case of First Branchial Cleft Fistula Presenting with an External Opening on the Root of the Helical Crus. Case Rep Med 2018; 2018:4215802. [PMID: 29560006 PMCID: PMC5831870 DOI: 10.1155/2018/4215802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/02/2018] [Indexed: 11/17/2022] Open
Abstract
Background First branchial cleft anomalies (FBCA) are rare clinical entities of the head and neck. Typically, the tract of the FBCA begins in the external auditory canal and ends in the postauricular or submandibular region. Case Presentation We present a case of a 23-year-old man who had a first branchial cleft fistula with atypical opening on the root of the helical crus. Complete excision of the tract, including the cuff of surrounding cartilage, was performed. Histopathology revealed a fistular tract lined with squamous epithelium. To our knowledge, this is the first case to be reported of type I FBCA with an opening on the root of the helical crus. The low incidence and varied presentation often result in misdiagnosis and inappropriate treatment. Conclusions In the patients with FBCA, careful recognition of atypical variants is essential for complete excision.
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Ha EJ, Baek SM, Baek JH, Shin SY, Han M, Kim CH. Efficacy and Safety of Ethanol Ablation for Branchial Cleft Cysts. AJNR Am J Neuroradiol 2017; 38:2351-2356. [PMID: 28970243 DOI: 10.3174/ajnr.a5373] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 07/10/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Branchial cleft cyst is a common congenital lesion of the neck. This study evaluated the efficacy and safety of ethanol ablation as an alternative treatment to surgery for branchial cleft cyst. MATERIALS AND METHODS Between September 2006 and October 2016, ethanol ablation was performed in 22 patients who refused an operation for a second branchial cleft cyst. After the exclusion of 2 patients who were lost to follow-up, the data of 20 patients were retrospectively evaluated. All index masses were confirmed as benign before treatment. Sonography-guided aspiration of the cystic fluid was followed by injection of absolute ethanol (99%) into the lesion. The injected volume of ethanol was 50%-80% of the volume of fluid aspirated. Therapeutic outcome, including the volume reduction ratio, therapeutic success rate (volume reduction ratio of >50% and/or no palpable mass), and complications, was evaluated. RESULTS The mean index volume of the cysts was 26.4 ± 15.7 mL (range, 3.8-49.9 mL). After ablation, the mean volume of the cysts decreased to 1.2 ± 1.1 mL (range, 0.0-3.5 mL). The mean volume reduction ratio at last follow-up was 93.9% ± 7.9% (range, 75.5%-100.0%; P < .001). Therapeutic success was achieved in all nodules (20/20, 100%), and the symptomatic (P < .001) and cosmetic (P < .001) scores had improved significantly by the last follow-up. In 1 patient, intracystic hemorrhage developed during the aspiration; however, no major complications occurred in any patient. CONCLUSIONS Ethanol ablation is an effective and safe treatment for patients with branchial cleft cysts who refuse, or are ineligible for, an operation.
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Affiliation(s)
- E J Ha
- From the Departments of Radiology (E.J.H., M.H.)
| | - S M Baek
- Department of Radiology (S.M.B., S.Y.S.), Sharing and Happiness Hospital, Busan, Korea
| | - J H Baek
- Department of Radiology and Research (J.H.B.), Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - S Y Shin
- Department of Radiology (S.M.B., S.Y.S.), Sharing and Happiness Hospital, Busan, Korea
| | - M Han
- From the Departments of Radiology (E.J.H., M.H.)
| | - C-H Kim
- Otolaryngology (C.-H.K.), Ajou University School of Medicine, Suwon, Korea
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Second Branchial Anomalies: A Study of 94 Cases. Indian J Otolaryngol Head Neck Surg 2017; 69:540-543. [PMID: 29238688 DOI: 10.1007/s12070-017-1195-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022] Open
Abstract
Ninety-four patients with second branchial anomalies were retrospectively analysed at a tertiary care centre from January 2006 to September 2016 to determine the demographical data and management. Branchial sinus and fistula presented earlier as compared to branchial cyst. The mean age at presentation in case of branchial sinuses, fistulae and cysts was 5.07, 5.79 and 7.31 years respectively. There was preponderance in males as compared to females, more so in bilateral cases. Male to female sex ratio was 2.91:1. The branchial fistulae were the most common type of lesions, followed by the branchial sinuses. The branchial anomalies were more on the right side (65.96%) probably due to right handedness of the population. Only eight patients (8.51%) had bilateral anomalies. Four patients had familial association, it was seen in bilateral cases and they presented earlier than unilateral cases. Early and complete surgical excision is the treatment of choice. Preoperative sinogram/fistulogram and intraoperative methylene blue dye injection is not mandatory for excision of a branchial sinus/fistula. Post-operative wound infection was the most common complication (4.25%).
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Al-Mufarrej F, Stoddard D, Bite U. Branchial arch anomalies: Recurrence, malignant degeneration and operative complications. Int J Pediatr Otorhinolaryngol 2017; 97:24-29. [PMID: 28483243 DOI: 10.1016/j.ijporl.2017.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 03/11/2017] [Accepted: 03/11/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Branchial arch anomalies (BAA) represent one of the commonest pediatric neck masses, but large case series are lacking with none specifically examining risk of recurrence, surgical complications, and malignancy. STUDY DESIGN Retrospective study of patients with BAA at Mayo Clinic from 1/1/1976-7/29/2011. METHODS Features studied include age, gender, location, BAA type, symptoms, recurrence, preoperative management, extent of surgery, pathology as well as presence of tracts. Associations with tracts, operative complications, and recurrence were evaluated. RESULTS 421 subjects underwent BAA excision during the study period at our institution. Subjects with tracts were symptomatic earlier. Four cases (mean age 60.3 years) of malignancy were identified. Among the 358 (non-remenant) BAA patients with no previous excision, 3.6% recurred at a mean of 47.1 months following surgery. Patients who underwent incision and drainage prior to BAA excision were 3.4 times more likely to recur. 2% experienced complications. Age, BAA type, preoperative imaging and extent of surgery did not affect recurrence or complication rates. CONCLUSION Patients with history of preoperative incision and drainage should be followed closely for recurrence the first four years. Early BAA excision is not associated with higher complication rate. Extent of resection should be determined by gross margins of BAA. Malignant degeneration was not seen in children. Malignancies have been seen in older patients (over 45 years) diagnosed with BAA, and a thorough work-up is important for correct diagnosis.
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Affiliation(s)
- Faisal Al-Mufarrej
- Wayne State School of Medicine, Department of Surgery, MN, United States
| | - David Stoddard
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, United States
| | - Uldis Bite
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, United States.
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Li W, Zhao L, Xu H, Li X. First branchial cleft anomalies in children: Experience with 30 cases. Exp Ther Med 2017; 14:333-337. [PMID: 28672934 PMCID: PMC5488406 DOI: 10.3892/etm.2017.4511] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 05/15/2017] [Indexed: 12/15/2022] Open
Abstract
First branchial cleft anomalies (FBCA) are rare in the clinical setting, as they account for 1 to 8% of all branchial abnormalities. The purpose of this study is to explore the relationship between the fistula tract and facial nerve and the surgical method of FBCA. This retrospective study included 30 cases of FBCA in children managed from 2009 to 2016. All patients underwent surgery to remove the tract of the FBCA. We reviewed the clinical data of the patients to obtain their demographics and management. Thirty patients (11 male and 19 female) with anomalies of FBCA were diagnosed. The ages ranged from 1 to 13 years (median, 3 years). Twenty cases had a close relationship with the parotid gland. The facial nerve was identified in 20 of the 30 patients. The tract ran deep to the facial nerve in 3 cases, superficial to it in 21 cases, and passed between the branches of the nerve in 6 cases. The facial nerve was not identified in ten patients, as the tract was superficial to it. There were 2 cases of postoperative temporary facial paralysis (2/30, 6.7%). The symptoms gradually improved after one month, 1 case had permanent facial paralysis (1/30, 3.3%), and 1 case had postoperative recurrence. Complete excision of the tract is the only way to manage FBCA, and the course of the tracts vary and have different relationships with the facial nerve. There are 3 types: Superficial, deep to the facial nerve, and between the branches of the nerve. Therefore, surgical approaches differ among the various types, and careful preoperative planning and protecting the facial nerve during resection of the tract are essential.
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Affiliation(s)
- Wanpeng Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, P.R. China
| | - Liming Zhao
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, P.R. China
| | - Hongming Xu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, P.R. China
| | - Xiaoyan Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, P.R. China
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Ferzli GS, Thakkar P, Goldstein NA, Chernichenko N. Third Branchial Cleft Cyst with Mycobacterium Infection. OTO Open 2017; 1:2473974X17705832. [PMID: 30480182 PMCID: PMC6239023 DOI: 10.1177/2473974x17705832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/07/2017] [Accepted: 03/30/2017] [Indexed: 11/16/2022] Open
Affiliation(s)
- George S. Ferzli
- State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Punam Thakkar
- State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Nira A. Goldstein
- State University of New York Downstate Medical Center, Brooklyn, New York, USA
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Tong F, Liang Y, Khan MF, Zhang L, Li W, Mahmoodurrahman M, Zhou Y. A fatal case of severe neck abscess due to a third branchial cleft fistula: morphologic and immunohistochemical analyses. Diagn Pathol 2016; 11:87. [PMID: 27628180 PMCID: PMC5024451 DOI: 10.1186/s13000-016-0540-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 09/06/2016] [Indexed: 11/10/2022] Open
Abstract
Background Branchial cleft anomalies constitute a frequently encountered and commonly non-lethal disease in otolaryngology, and result from aberrant embryonic development. The third branchial cleft fistula is one of the four known specific types of branchial cleft anomalies, and always presents as recurrent neck abscess and suppurative thyroiditis. Here, we report an unexpected death due to severe neck infection following a third branchial cleft fistula. Case presentation A 19-year-old man was sent to the hospital with a 1-week history of recurrent left-sided neck abscess, and was scheduled for incision and drainage of the abscess. However, before the surgery was performed, the man’s condition deteriorated and he died. A review of his medical history showed that he had undergone a previous incision and drainage for a neck abscess 2 years ago. Postmortem examination revealed that the fatal neck abscess was induced by a third branchial cleft fistula. Conclusions We conclude that a histopathological examination of neck tissue combined with a detailed review of medical history and examination of ultrasonographic and CT images can provide a rapid and accurate diagnosis of third branchial cleft fistula. This common, non-lethal disease can potentially lead to death if the neck infection is not properly diagnosed and treated. In medico-legal practice, medical examiners should be aware of this condition, as this knowledge would be important in the diagnosis of the cause of death.
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Affiliation(s)
- Fang Tong
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Hankou, Wuhan, 430030, People's Republic of China
| | - Yue Liang
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Hankou, Wuhan, 430030, People's Republic of China
| | | | - Lin Zhang
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Hankou, Wuhan, 430030, People's Republic of China
| | - Wenhe Li
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Hankou, Wuhan, 430030, People's Republic of China
| | | | - Yiwu Zhou
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Hankou, Wuhan, 430030, People's Republic of China.
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Rajkumar JS, Ganesh D, Anirudh JR, Akbar S, Joshi N. First Branchial Arch Fistula: A Rarity and a Surgical Challenge. J Clin Diagn Res 2016; 10:PD19-21. [PMID: 27504352 DOI: 10.7860/jcdr/2016/16730.8019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 03/16/2016] [Indexed: 11/24/2022]
Abstract
Although 2(nd) Branchial arch fistulae (from incomplete closure of Cervical sinus of His) are well known, 1(st) arch fistulae are much rarer (<10%) and are usually not tackled comprehensively. We present a case of a rare first branchial arch fistula of the type II Arnot classification, which presented with two external openings of more than 20 years duration. Patient had a successful resection of all the concerned fistulous tract. Review of literature and the surgical challenges of the procedure are presented herewith.
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Affiliation(s)
- J S Rajkumar
- Chairman & Advanced Laparoscopic Surgeon, Department of Minimal Access Surgery, LifeLine RIGID Hospitals , Kilpauk, Chennai, India
| | - Deepa Ganesh
- Consultant Laparoscopic Surgeon, Department of Minimal Access Surgery, LifeLine RIGID Hospitals , Kilpauk, Chennai, India
| | - J R Anirudh
- Assistant Surgeon, Department of Minimal Access Surgery, LifeLine RIGID Hospitals , Kilpauk, Chennai, India
| | - S Akbar
- Assistant Surgeon, Department of Minimal Access Surgery, LifeLine RIGID Hospitals , Kilpauk, Chennai, India
| | - Niraj Joshi
- Consultant ENT Surgeon, Department of ENT, LifeLine RIGID Hospitals , Kilpauk, Chennai, India
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A Rare Case Report of a Child Coexistence Thyroglossal Cyst and Second Branchial Cleft Fistulae. Indian J Otolaryngol Head Neck Surg 2016; 69:263-265. [PMID: 28607902 DOI: 10.1007/s12070-016-0995-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 05/10/2016] [Indexed: 01/05/2023] Open
Abstract
Thyroglossal duct cysts followed by branchial cleft anomalies are the most common congenital neck masses encountered in practice, second branchial cleft cysts and sinuses are the most common type (LaRiviere and Waldhausen in Surg Clin North Am 92(3):583-597, 2012). Although both abnormalities are common individually, but rarely seen associated in same patient as described in our case. Congenitalcervical anomalies are important to consider in the differential of head and neck masses in children and adults. These lesions can present as palpable cystic masses, infected masses, draining sinuses, or fistulae. Thyroglossal duct cysts are most common, followed by branchial cleft anomalies. A synchronous presentation of both type of cyst and fistula in a same child patient is very rare with no such cases reported in literature till date.
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Schmidt K, Leal A, McGill T, Jacob R. Rapidly enlarging neck mass in a neonate causing airway compromise. Proc (Bayl Univ Med Cent) 2016; 29:183-4. [PMID: 27034563 DOI: 10.1080/08998280.2016.11929409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Up to 20% of all congenital pediatric head and neck masses are branchial cleft cysts. Second branchial cleft cysts account for 95% of branchial anomalies, and fourth branchial cleft cysts are the rarest type. Their typical presentations include non-life-threatening symptoms, such as drainage, skin irritations, minor swelling, and tenderness. We describe a 5-week-old neonate with increasing stridor secondary to a rapidly growing neck mass. Imaging and surgical excision confirmed the mass to be an infected fourth branchial cleft cyst.
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Affiliation(s)
- Kyra Schmidt
- Texas Tech University Health Sciences Center School of Medicine (Schmidt); and the Departments of Surgery (Leal, McGill) and Radiology (Jacob), Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas
| | - Andres Leal
- Texas Tech University Health Sciences Center School of Medicine (Schmidt); and the Departments of Surgery (Leal, McGill) and Radiology (Jacob), Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas
| | - Thomas McGill
- Texas Tech University Health Sciences Center School of Medicine (Schmidt); and the Departments of Surgery (Leal, McGill) and Radiology (Jacob), Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas
| | - Roy Jacob
- Texas Tech University Health Sciences Center School of Medicine (Schmidt); and the Departments of Surgery (Leal, McGill) and Radiology (Jacob), Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas
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Piccioni M, Bottazzoli M, Nassif N, Stefini S, Nicolai P. Intraoperative use of fibrin glue dyed with methylene blue in surgery for branchial cleft anomalies. Laryngoscope 2016; 126:2147-50. [PMID: 26927898 DOI: 10.1002/lary.25833] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVES/HYPOTHESIS We present a new method of optimizing the results of surgery for branchial cleft anomalies based on the intraoperative injection of fibrin glue combined with methylene blue dye. STUDY DESIGN Retrospective single-center cohort study. METHODS The method was applied in 17 patients suffering from branchial anomalies. Six (35.29%) had a preauricular lesion; three (17.65%) had lesions derived from the first arch/pouch/groove (type I), four (23.53%) had lesions derived from the first (type II), one (5.88%) had lesions derived from the second, one (5.88%) had lesions derived from the third, and two (11.76%) had lesions derived from the fourth. The median and mean age at surgery were 10 and 10.6 years, respectively. All patients were followed by periodic clinical and ultrasonographic examination. RESULTS The combination of fibrin glue with methylene blue facilitated the correct assessment of the extension of the lesions and their intraoperative manipulation. After a mean follow-up of 47.8 months, all patients were free of disease. CONCLUSIONS Intraoperative injection of branchial fistulae and cysts by a mixture of fibrin glue and methylene blue is an effective, easy, and safe tool to track lesions and achieve radical resection. The technique requires a definitive validation on a large cohort with adequate stratification of patients. LEVEL OF EVIDENCE 4 Laryngoscope, 126:2147-2150, 2016.
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Affiliation(s)
- Michela Piccioni
- Department of Pediatric Otolaryngology, Spedali Civili, Brescia, Italy
| | - Marco Bottazzoli
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Nader Nassif
- Department of Pediatric Otolaryngology, Spedali Civili, Brescia, Italy
| | - Stefania Stefini
- Department of Pediatric Otolaryngology, Spedali Civili, Brescia, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
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Surgical Approaches to First Branchial Cleft Anomaly Excision: A Case Series. Case Rep Otolaryngol 2016; 2016:3902974. [PMID: 27034873 PMCID: PMC4789415 DOI: 10.1155/2016/3902974] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 02/10/2016] [Indexed: 11/19/2022] Open
Abstract
Objectives. First branchial cleft anomalies (BCAs) constitute a rare entity with variable clinical presentations and anatomic findings. Given the high rate of recurrence with incomplete excision, identification of the entire tract during surgical treatment is of paramount importance. The objectives of this paper were to present five anatomic variations of first BCAs and describe the presentation, evaluation, and surgical approach to each one. Methods. A retrospective case review and literature review were performed. We describe patient characteristics, presentation, evaluation, and surgical approach of five patients with first BCAs. Results. Age at definitive surgical treatment ranged from 8 months to 7 years. Various clinical presentations were encountered, some of which were atypical for first BCAs. All had preoperative imaging demonstrating the tract. Four surgical approaches required a superficial parotidectomy with identification of the facial nerve, one of which revealed an aberrant facial nerve. In one case the tract was found to travel into the angle of the mandible, terminating as a mandibular cyst. This required en bloc excision that included the lateral cortex of the mandible. Conclusions. First BCAs have variable presentations. Complete surgical excision can be challenging. Therefore, careful preoperative planning and the recognition of atypical variants during surgery are essential.
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Hwang J, Kim SC, Kim DY, Namgoong JM, Nam SY, Roh JL. Excision versus trichloroacetic acid (TCA) chemocauterization for branchial sinus of the pyriform fossa. J Pediatr Surg 2015; 50:1949-53. [PMID: 26282101 DOI: 10.1016/j.jpedsurg.2015.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 06/28/2015] [Accepted: 07/01/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE We analyzed the outcomes of open surgical excision and endoscopic trichloroacetic acid (TCA) chemocauterization for the treatment of branchial sinus of the pyriform fossa (BSPF). METHOD We retrospectively reviewed the records of 27 patients (16 males and 11 females) who were treated for BSPF at the Asan Medical Center between 1996 and 2013. RESULTS The median age of the 27 patients was 4.5years (range, 0 to 15years). Before definitive surgery, 19 (70.3%) of the patients had histories of neck infection, and 16 (59.2%) patients had neck abscesses that were drained. The lesions were predominantly located on the left side (26 of 27; 96.2%). Excisions were performed for 14 (48.1%) patients. TCA chemocauterizations were performed for 13 patients. After a median follow-up period of 5.5years, 11 patients developed recurrence. The recurrence rates were not significantly different between the excision and chemocauterization groups (35.7% vs 46.1%, respectively, p=0.704). All of the recurred patients were successfully treated with repeated chemocauterization or reexcision. Analyses of the risk factors for recurrence revealed that a previous infection history tended to increase the rate of recurrence (90.9% vs 56.2%, p=0.090). CONCLUSION Our experience suggests that the outcomes of excision and TCA chemocauterization are not significantly different. Additional studies are needed to reach a consensus regarding the best treatment strategy for BSPF.
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Affiliation(s)
- Jihee Hwang
- Division of Pediatric Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Seong Chul Kim
- Division of Pediatric Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
| | - Dae Yeon Kim
- Division of Pediatric Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Jung-Man Namgoong
- Division of Pediatric Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Jong-Lyel Roh
- Department of Otolaryngology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
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48
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Codreanu CM, Codreanu C, Codreanu M. First branchial cleft fistula: a difficult challenge. Braz J Otorhinolaryngol 2015; 83:364-366. [PMID: 26541234 PMCID: PMC9444734 DOI: 10.1016/j.bjorl.2015.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 07/16/2015] [Indexed: 12/04/2022] Open
Affiliation(s)
| | - Corneliu Codreanu
- Brăila County Hospital, Department of Otolaryngology, Braila, Romania
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49
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Patel JB, Kilbride H, Paulson L. Neonatal Presentation of an Air-Filled Neck Mass that Enlarges with Valsalva: A Case Report. AJP Rep 2015; 5:e207-11. [PMID: 26495186 PMCID: PMC4603868 DOI: 10.1055/s-0035-1563388] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 06/29/2015] [Indexed: 12/30/2022] Open
Abstract
Branchial cleft cysts are common causes of congenital neck masses in the pediatric population. However, neonatal presentation of branchial cleft cysts is uncommon, but recognizable secondary to acute respiratory distress from airway compression or complications secondary to infection. We report a 1-day-old infant presenting with an air-filled neck mass that enlarged with Valsalva and was not associated with respiratory distress. The infant was found to have a third branchial cleft cyst with an internal opening into the pyriform sinus. The cyst was conservatively managed with endoscopic surgical decompression and cauterization of the tract and opening. We review the embryology of branchial cleft cysts and current management.
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Affiliation(s)
- Jasminkumar Bharatbhai Patel
- Division of Neonatology, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Howard Kilbride
- Division of Neonatology, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Lorien Paulson
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
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50
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Larem A, Sheikh R, Al Qahtani A, Khais F, Ganesan S, Haidar H. Oropharyngeal trauma mimicking a first branchial cleft anomaly. Laryngoscope 2015; 126:E224-E226. [PMID: 26372111 DOI: 10.1002/lary.25643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 11/09/2022]
Abstract
We present a unique and challenging case of a remnant foreign body that presented to us in a child disguised as a strongly suspected congenital branchial cleft anomaly. This case entailed oropharyngeal trauma, with a delayed presentation as a retroauricular cyst accompanied by otorrhea that mimicked the classic presentation of an infected first branchial cleft anomaly. During surgical excision of the presumed branchial anomaly, a large wooden stick was found in the tract. The diagnostic and therapeutic obstacles in the management of such cases are highlighted. In addition to exploring the existing literature, we retrospectively analyzed a plausible explanation of the findings of this case. Laryngoscope, 126:E224-E226, 2016.
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Affiliation(s)
- Aisha Larem
- Otorhinolaryngology, Head and Neck Surgery, Department of Surgery, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medical College, Doha, Qatar
| | - Rashid Sheikh
- Otorhinolaryngology, Head and Neck Surgery, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Abdulsalam Al Qahtani
- Otorhinolaryngology, Head and Neck Surgery, Department of Surgery, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medical College, Doha, Qatar
| | - Frat Khais
- Otorhinolaryngology, Head and Neck Surgery, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Shanmugam Ganesan
- Otorhinolaryngology, Head and Neck Surgery, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Haidar
- Otorhinolaryngology, Head and Neck Surgery, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
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