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Jia XY, He KX, Dong YB, Liu YH, Lu C, Li WX. Endoscopic Dyeing and Plasma Coblation-Assisted Open Neck Surgery for Pyriform Fossa Branchial Apparatus Anomalies in Adults. EAR, NOSE & THROAT JOURNAL 2024:1455613241253924. [PMID: 38813945 DOI: 10.1177/01455613241253924] [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: 05/31/2024] Open
Abstract
Objective: Pyriform fossa (PF) branchial apparatus anomalies (PFBAA) are rare congenital third or fourth branchial apparatus anomalies (TBAA or FBAA). This article summarizes our paradigm in managing this condition by combining endoscopic procedures and open neck surgery. Methods: A retrospective review was undertaken concerning PFBAA cases treated at our tertiary medical institution between July 2020 and November 2023. Data were collected from case records. Three sequential steps were implemented: (1) direct laryngoscopy to identify internal orifice (IO), with injection of methylene blue into it; (2) open neck surgery to resect all inflammatory tissues, focusing on the ligation of the sinus tract out of PF; and (3) plasma coblation of IO mucosa. Results: In total, 7 cases (4 men and 3 women) were included (28-67 years old, median age 53). Presenting symptoms were various, with 6 lesions on the left and 1 on the right side. Preoperative (PO) fiberoptic laryngoscopy identified IO in 6 patients, while PO barium esophageal study identified outflow from PF in 4 patients. A preliminary diagnosis of PFBAA could be established in all cases (2 TBAA and 5 FBAA cases). Direct laryngoscopy after general anesthesia identified IO in all cases (2 on the base of PF and 5 on the apex of PF). All the surgical procedures were successful, with uneventful recovery in all the patients. No postoperative complications were observed. All the patients resumed oral fluid intake after confirmation of no pharyngeal fistula by barium esophageal study on the seventh postoperative day. The duration of follow-up was between 6 and 40 months (with a median duration of 27 months). No recurrence was observed. Conclusion: Open neck surgery, assisted by endoscopic dyeing of sinus tracts and plasma coblation of IO mucosa, is a suitable treatment for PFBAA in adults. This paradigm is effective and safe for senior surgeons.
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Affiliation(s)
- Xiao-Ying Jia
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Kai-Xuan He
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yan-Bo Dong
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yu-He Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Cheng Lu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wan-Xin Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Paul I, Mohiyuddin SMA, A S, Mohammadi K, Babu P. The Outcome of Treatment in Second Branchial Cleft Anomalies: A Case Series. Cureus 2023; 15:e40164. [PMID: 37431352 PMCID: PMC10329747 DOI: 10.7759/cureus.40164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 07/12/2023] Open
Abstract
Background Branchial-cleft anomalies are second only to thyroglossal duct anomalies among congenital malformations of the neck, and second branchial-cleft anomalies are the most common. These include branchial cysts, branchial sinuses, and branchial fistulas. Clinical symptoms include neck swelling and a discharging sinus or fistula opening. In a small number of cases, they can lead to major complications like abscesses or malignant changes. Surgical resection is the treatment of choice. Various approaches to resection and sclerotherapy have been tried. In this study, we present our treatment outcome with branchial cleft anomalies at a rural tertiary medical care hospital. Objectives To document the various presentations, clinical features, and outcomes of treatment with second branchial cleft anomalies. Methods This retrospective observational study included 16 patients operated on for second branchial-cleft anomalies. A detailed medical history was elicited, and an accurate clinical examination was done. A contrast-enhanced computed tomography (CECT) scan was done in all cases. A few cases required a fistulogram. The cysts, sinuses, or fistulas were resected en bloc by a single neck crease incision. Primary closure was done in all cases. A recurrence or pharyngocutaneous fistula required axial flap reconstruction. The complications and recurrences were documented. Result There were six children and 10 adults in our study. Seven cysts, five sinuses, and four fistulas were present, of which four were iatrogenic. In seven patients, imaging could not show the entire tract. There were four fistulas from the oropharynx to a cutaneous opening in the neck. A complete resection was done for all. Two pharyngocutaneous fistulas were treated with a pectoralis major myocutaneous (PMMC) flap. Three patients had wound dehiscence postoperatively. None of the patients had neurological or vascular injuries. Conclusion Second branchial cleft anomalies can be completely excised by a single neck crease incision. Meticulous surgery results in a low recurrence or complication rate. Following complete excision, in type IV anomalies, a purse-string suture at the pharyngeal opening ensures good closure and no recurrences.
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Affiliation(s)
- Indranil Paul
- Otorhinolaryngology & Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - S M Azeem Mohiyuddin
- Otorhinolaryngology & Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Sagayaraj A
- Otorhinolaryngology & Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Kouser Mohammadi
- Otorhinolaryngology & Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Prashanth Babu
- Otorhinolaryngology & Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
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Kawakubo N, Obata S, Yoshimaru K, Miyoshi K, Izaki T, Tajiri T. Successful management of pyriform sinus cyst and fistula using endoscopic electrocauterization. DEN OPEN 2023; 3:e128. [PMID: 35898836 PMCID: PMC9307728 DOI: 10.1002/deo2.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Pyriform sinus cyst (PSC) and pyriform sinus fistula (PSF) is a rare congenital malformation that arises from the third or fourth branchial structure. In our study, we describe the safety and the utility of endoscopic electrocauterization against PSC/PSF. METHODS We retrospectively reviewed the records of patients who underwent endoscopic electrocauterization for PSC/PSF at our hospital. The internal opening of the fistula was identified under general anesthesia using a flexible endoscope (XQ-260 or H-290; Olympus, Tokyo, Japan), and the DualKnifeJ (KD-655L; Olympus) was used to ablate the internal opening. RESULTS We experienced three PSF and three PSC patients. The postoperative course was uneventful in all cases. The patients declared no pain in the neck, and there were no cases showing recurrent nerve paralysis. Five in six cases (83%), the closure of fistula was archived in the first cauterization. One case (16.6%) required repeated cauterization. No recurrence was found during the follow-up period ( median: 1 year) in any cases. CONCLUSIONS Owing to its rarity in neonates, the diagnosis and treatment of PSC remains complicated and not clearly described. Complete removal of the fistula and the cyst with or without affected thyroid tissue was previously the most commonly used treatment. From our experience, we believe that endoscopic electrocauterization can be the first choice not only for PSF but also for neonatal PSC. In conclusion, endoscopic electrocauterization is feasible even for neonatal PSC. Further investigations including multicenter analyses are needed.
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Affiliation(s)
- Naonori Kawakubo
- Department of Pediatric SurgeryFaculty of Medical SciencesKyushu UniversityFukuokaJapan
| | - Satoshi Obata
- Department of Pediatric SurgeryFaculty of Medical SciencesKyushu UniversityFukuokaJapan
| | - Koichiro Yoshimaru
- Department of Pediatric SurgeryFaculty of Medical SciencesKyushu UniversityFukuokaJapan
| | - Kina Miyoshi
- Department of Pediatric SurgeryFaculty of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Pediatric SurgeryMiyazaki Prefectural HospitalMiyazakiJapan
| | - Tomoko Izaki
- Department of Pediatric SurgeryFaculty of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Pediatric SurgeryOita Prefectural HospitalOitaJapan
| | - Tatsuro Tajiri
- Department of Pediatric SurgeryFaculty of Medical SciencesKyushu UniversityFukuokaJapan
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Vázquez-Román V, Fernández-Santos JM, Martín-Lacave I. C-cell differentiation in the wall of an aberrant ultimobranchial sinus in the thyroid gland of an old rat. Vet Med Sci 2023; 9:876-883. [PMID: 36370461 PMCID: PMC10029892 DOI: 10.1002/vms3.998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In mammals, the thyroid gland possesses two types of endocrine cells, follicular cells and C cells, which have different functions but share a similar endodermal origin (although from different regions of the primitive pharynx). Specifically, follicular cells derive from the ventral pharyngeal floor, while C cells derive from the fourth pair of pharyngeal pouches through the ultimobranchial bodies (UBBs). Disruptions to human midline thyroid morphogenesis are relatively frequent and known as thyroid dysgenesis, which is the leading cause of congenital hypothyroidism. In contrast, fourth branchial apparatus anomalies are very rare clinical entities. OBJECTIVES The aim of this study was to analyze the morphological features and the immunohistochemical pattern of an aberrant ultimobranchial remnant, align with its persistent contribution to the formation of new C cells. METHODS The thyroid gland of an old rat was serially sectioned and immunostained for the following markers: calcitonin, thyroglobulin, cytokeratins, PCNA, P63, E-cadherin, beta-tubulin and CD3. RESULTS We detected a spontaneous congenital defect in the organogenesis of the UBB in an old rat, giving rise to an 'ultimobranchial sinus', which was accompanied by thymic tissue and an abscess. The epithelium contained basal/stem cells and contributed to the formation of abundant C cells and scarce follicular cells. CONCLUSIONS The ultimobranchial sinus is an exceptional finding for representing the first spontaneous abnormality in the development of UBB reported in rats, and the opportunity to observe sustained C-cell differentiation from stem cells in an old rat. These findings are consistent with a common origin of both C cells and follicular cells from UBB.
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Affiliation(s)
- Victoria Vázquez-Román
- Departamento de Citología e Histología Normal y Patológica, Facultad de Medicina, Universidad de Sevilla, Sevilla, Andalucía, Spain
| | - José M Fernández-Santos
- Departamento de Citología e Histología Normal y Patológica, Facultad de Medicina, Universidad de Sevilla, Sevilla, Andalucía, Spain
| | - Inés Martín-Lacave
- Departamento de Citología e Histología Normal y Patológica, Facultad de Medicina, Universidad de Sevilla, Sevilla, Andalucía, Spain
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宫 喜, 陈 良, 许 咪, 黄 艳, 梁 璐, 张 贝, 黄 舒, 盛 晓, 徐 贤. [Clinical application of modified fistulectomy in the treatment of congenital pyriform sinus fistula based on segmental anatomy of fistula]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2023; 37:87-91. [PMID: 36756820 PMCID: PMC10208858 DOI: 10.13201/j.issn.2096-7993.2023.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Indexed: 02/10/2023]
Abstract
Objective:To discuss the clinical application and significance of the modified piriform fossa fistulectomy based on segmental anatomy of fistula. Methods:The clinical data of 84 patients with CPSF treated by modified pyriform sinus fistulectomy were analyzed retrospectively. The modified piriform fossa fistula resection adopts the fistula anterograde anatomy method to fine dissect the fistula. The operation procedure can be summarized into four parts: retrograde anatomy of recurrent laryngeal nerve, anatomy of external branch of superior laryngeal nerve, anterograde anatomy of fistula and partial thyroidectomy. Results:All 84 patients successfully completed the operation and discharged from the hospital. The operation time was(64.6±20.0) min, the intraoperative bleeding was(19.6±13.0) mL, and the average hospital stay was(6.8±1.1) d. Postoperative infection occurred in 1 case(1.19%), temporary vocal cord paralysis in 1 case(1.19%), no bleeding, pharyngeal fistula, dysphagia, permanent vocal cord paralysis and choking cough. The incidence of complications was 2.3%(2/84). No complications such as permanent vocal cord paralysis and hypothyroidism occurred. Follow up for 57-106(Median 74) months showed no recurrence. Conclusion:A modified procedure based on segmental dissection of the fistula not only simplifies the traditional procedure, but also procedures the specific steps to provide a targeted and precise resection, which provides a proven surgical solution for complete eradication of the lesion and significantly reduces complications and recurrence.
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Affiliation(s)
- 喜翔 宫
- 玉溪市人民医院 昆明医科大学第六附属医院耳鼻咽喉头颈外科(云南玉溪,653100)Department of Otolaryngology Head and Neck Surgery, People's Hospital of Yuxi City, the Sixth Affiliated Hospital of Kunming Medical University, Yuxi, 653100, China
| | - 良嗣 陈
- 南方医科大学附属广东省人民医院(广东省医学科学院)耳鼻咽喉头颈外科Department of Otorhinolaryngology Head and Neck Surgery, Guangdong Provincial People's Hospital[Guangdong Academy of Medical Sciences], Southern Medical University
| | - 咪咪 许
- 南方医科大学附属广东省人民医院(广东省医学科学院)耳鼻咽喉头颈外科Department of Otorhinolaryngology Head and Neck Surgery, Guangdong Provincial People's Hospital[Guangdong Academy of Medical Sciences], Southern Medical University
| | - 艳 黄
- 南方医科大学附属广东省人民医院(广东省医学科学院)耳鼻咽喉头颈外科Department of Otorhinolaryngology Head and Neck Surgery, Guangdong Provincial People's Hospital[Guangdong Academy of Medical Sciences], Southern Medical University
| | - 璐 梁
- 广州市第一人民医院南沙医院耳鼻咽喉头颈外科Department of Otorhinolaryngology, Nansha Hospital of Guangzhou First People's Hospital
| | - 贝 张
- 香港大学深圳医院耳鼻咽喉头颈外科Department of Otorhinolaryngology Head and Neck Surgery, the University of Hong Kong-Shenzhen Hospital
| | - 舒玲 黄
- 深圳市儿童医院耳鼻咽喉头颈外科Department of Otorhinolaryngology Head and Neck Surgery, Shenzhen Children's Hospital
| | - 晓丽 盛
- 南方医科大学附属广东省人民医院(广东省医学科学院)耳鼻咽喉头颈外科Department of Otorhinolaryngology Head and Neck Surgery, Guangdong Provincial People's Hospital[Guangdong Academy of Medical Sciences], Southern Medical University
| | - 贤贞 徐
- 南方医科大学附属广东省人民医院(广东省医学科学院)耳鼻咽喉头颈外科Department of Otorhinolaryngology Head and Neck Surgery, Guangdong Provincial People's Hospital[Guangdong Academy of Medical Sciences], Southern Medical University
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Sobotková K, Urík M, Perce K, Petrová B, Šikolová S, Bartoš M, Jančíková J, Kula R, Jabandžiev P. Fourth branchial cleft anomaly in a 7-month-old infant: A case report and literature review. EAR, NOSE & THROAT JOURNAL 2022:1455613221106211. [PMID: 35768198 DOI: 10.1177/01455613221106211] [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: 11/15/2022] Open
Abstract
Fourth branchial cleft anomalies are rare head and neck congenital lesions seen in children. They present as a neck inflammatory mass and arise essentially on the left side of the neck. We report the case of a 7-month-old female with a mass of the neck associated with respiratory distress. The mass was diagnosed as an incomplete fourth branchial cleft fistula. Surgical revision of the neck abscess from an external approach and plasma coblation of the orifice in the pyriform fossa by an endoscopic approach were performed.
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Affiliation(s)
- Kateřina Sobotková
- Department of Paediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Milan Urík
- Department of Paediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Klára Perce
- Department of Paediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Barbora Petrová
- Department of Paediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Soňa Šikolová
- Department of Paediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Michal Bartoš
- Department of Paediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Jana Jančíková
- Department of Paediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Roman Kula
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Masaryk University Brno, Brno, Czech Republic
| | - Petr Jabandžiev
- Department of Pediatrics, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
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Congenital pyriform sinus fistula: Diagnosis and endoscopic treatment with video. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138 Suppl 1:25-26. [PMID: 34127410 DOI: 10.1016/j.anorl.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/19/2021] [Accepted: 05/03/2021] [Indexed: 11/22/2022]
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