Congenital fistula of the fourth branchial pouch.
Between 1986 and 1995, 128 patients were treated for various head and neck congenital malformations at Saint-Luc University Hospital, Louvain. We report three cases of fourth branchial pouch cysts requiring surgical removal. One of these cases presented with a third branchial pouch remnant on the same side and subsequently a fourth branchial pouch sinus. To our knowledge, this is the first case published in the literature. A fourth branchial pouch sinus tract can become manifest clinically by recurrent episodes of neck abscess or acute suppurative thyroiditis (especially in infants). The tract can be identified with a barium swallow during the period of latency and hypopharyngeal endoscopy under general anesthesia. Total excision of the fistula with dissection up to the pyriform sinus with or without a left thyroid gland lobectomy and isthmectomy is the treatment of choice.
Department of Otolaryngology, Head and Neck Surgery Saint-Luc University Hospital, Brussels, Belgium.
M
M
Hamoir
P
P
Rombaux
A S
AS
Cornu
P
P
Clapuyt
D000038:Abscess / Q000209:etiology; D000293:Adolescent; D000328:Adult; D001466:Barium Sulfate; D001934:Branchial Region / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery; D001935:Branchioma / Q000151:congenital* / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D002675:Child, Preschool; D003287:Contrast Media; D004724:Endoscopy; D005260:Female; D006258:Head and Neck Neoplasms / Q000151:congenital* / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007830:Larynx / Q000601:surgery; D010614:Pharynx / Q000601:surgery; D012008:Recurrence; D013965:Thyroidectomy; D013969:Thyroiditis, Suppurative / Q000209:etiology; D014057:Tomography, X-Ray Computed
D003287:Contrast Media; D001466:Barium Sulfate