[A case report: anomaly of the fourth branchial pouch with recurring cervical abscesses. Cauterization with trichloroacetic acid closed the fistula opening and cured the patient].
A fourth branchial pouch sinus is a rare congenital anomaly, which in a 13-year-old girl presented clinically as recurrent deep cervical abscesses. The location of the majority of these anomalies is the left side of the neck (90%). Radiological and endoscopic investigations verified the diagnosis. The internal orifice located at the apex of the pyriform sinus could facilitate contamination by infectious pharyngeal secretions and lead to abscess recurrence. Traditionally, the recommended treatment is radical surgery. It can, however, be technically difficult to excise the whole fistula tract. In this patient we used a non-invasive treatment modality; chemocauterization with 40% trichloroacetic acid (TCA). After three treatments the fistula was closed. To date (month no. 15) there has been no abscess recurrence. TCA chemocauterization seems to be a safe first-line treatment for patients with pyriform sinus fistulas.
Stenquist
Monika
M
Oron-, näs- och halskliniken, Akademiska sjukhuset, Uppsala. monika.stenquist@ent.uas.lul.se
Juhlin
Claes
C
Aström
Gunnar
G
Friberg
Ulla
U
D000038:Abscess / Q000175:diagnosis / Q000209:etiology; D000293:Adolescent; D001934:Branchial Region / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology; D001935:Branchioma / Q000151:congenital / Q000175:diagnosis / Q000628:therapy; D002424:Caustics / Q000627:therapeutic use; D002425:Cautery / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D005402:Fistula / Q000151:congenital / Q000175:diagnosis / Q000628:therapy; D006258:Head and Neck Neoplasms / Q000151:congenital / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D011859:Radiography; D012008:Recurrence; D014238:Trichloroacetic Acid / Q000627:therapeutic use*
D002424:Caustics; D014238:Trichloroacetic Acid