Neonatal vs delayed-onset fourth branchial pouch anomalies: therapeutic implications.
OBJECTIVE
To determine the presentation of third or fourth branchial pouch anomalies in various age groups of children and evaluate endoscopic cauterization as a treatment technique.


METHODS
Retrospective study of patients treated from 2000 to 2009.


METHODS
Tertiary care children's hospital.


METHODS
Pediatric patients aged 0 to 18 years (mean age, 5.5 years), including 5 neonates.


METHODS
Endoscopic and/or open surgical management of third and fourth branchial pouch anomalies; clinical and endoscopic follow-up.


METHODS
Absence of clinical recurrence; closure of the sinus tract.


RESULTS
Two forms of presentation were identified: a neonatal form, characterized by a voluminous and compressive cervical mass (5 of 20 [25%]) and a childhood form, presenting as a cervical abscess (15 of 20 [75%]). The vast majority of our patients regardless of presentation were treated endoscopically (n = 19), with a success rate of 68% (13 of 19) after 1 procedure, 79% (15 of 19) after 2 procedures, and 89% (17 of 19) after 3 procedures. Neonatal and adult presentations require slightly different therapeutic approaches.


CONCLUSIONS
Third and fourth branchial pouch anomalies can present in 2 distinct forms: a neonatal form and a childhood form. The endoscopic technique should be the favored approach for both forms: whenever possible, in view of its simplicity, rapidity, and the lack of serious postoperative complications. Recurrences can be treated by repeated cauterization using the same technique, with good long-term outcomes. An age-based management algorithm has been developed.
Leboulanger
Nicolas
N
Université Pierre et Marie Curie, Institut National de la Santé et de la Recherche Médicale U-587, and Department of Pediatric Otolaryngology–Head and Neck Surgery, Armand-Trousseau Children’s Hospital, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France. nicolas.leboulanger@trs.aphp.fr
Ruellan
Katell
K
Nevoux
Jérôme
J
Pezzettigotta
Stéphane
S
Denoyelle
Françoise
F
Roger
Gilles
G
Garabedian
Eréa-Noël
EN
D000293:Adolescent; D017668:Age of Onset; D001934:Branchial Region / Q000002:abnormalities* / Q000601:surgery*; D001935:Branchioma / Q000151:congenital / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004564:Electrocoagulation; D004724:Endoscopy; D005260:Female; D006258:Head and Neck Neoplasms / Q000151:congenital / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053685:Laser Therapy; D008297:Male