title: Management of anomalies of the third and fourth branchial pouches.
abstract: Third and fourth branchial pouch anomalies are rare and usually present as lateral neck masses, abscesses or with acute suppurative thyroiditis. An opening in the piriform sinus can be identified in most cases. We present four cases of fourth branchial pouch sinuses, one of a third branchial cyst and discuss our management. Cannulation of the sinus tract at laryngoscopy, followed by complete surgical excision, via a modified oblique thyrotomy above the cricothyroid joint after detaching the inferior constrictor was used to treat the fourth branchial pouch anomalies. This surgical approach adequately exposes the piriform sinus apex and also affords protection to the recurrent laryngeal nerve. The third pouch cyst and tract were excised at the level of the thyrohyoid membrane. There were no complications or recurrences.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Houston Medical School, University of Texas, 6431 Fannin, Suite 6.112, Houston, TX 77030, USA. kevin.d.pereira@uth.tmc.edu
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Pereira
authors.forename: Garrett G
authors.initials: GG
authors.lastname: Losh
authors.forename: Dwight
authors.initials: D
authors.lastname: Oliver
authors.forename: Michael D
authors.initials: MD
authors.lastname: Poole
mesh_terms: D000038:Abscess / Q000209:etiology / Q000601:surgery; D000293:Adolescent; D001934:Branchial Region / Q000002:abnormalities*; D001935:Branchioma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D002404:Catheterization / Q000379:methods; D002675:Child, Preschool; D005402:Fistula / Q000209:etiology / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007828:Laryngoscopy; D008279:Magnetic Resonance Imaging; D008297:Male; D013517:Otorhinolaryngologic Surgical Procedures; D013965:Thyroidectomy / Q000379:methods; D013966:Thyroiditis / Q000209:etiology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome