title: [Diagnosis and treatment of congenital fourth branchial anomaly].
abstract: OBJECTIVE
  To discuss the anatomic features, clinical presentations, diagnosis, differentiations and treatments of congenital fourth branchial anomaly(CFBA).
  
  
  METHODS
  The clinical data of 8 patients with CFBA were retrospectively analyzed.
  
  
  RESULTS
  Of the 8 patients aging from 27 to 300 months (median age: 114 months), 4 male and 4 female; 3 untreated previously and 5 recurrent. All lesions, including 1 cyst, 3 sinus (with internal opening) and 4 fistula, located in the left necks. Three patients presented acute suppurative thyroiditis, 4 deep neck abscesses, and 1 neck lump. Preoperative examinations included barium esophagogram, direct laryngoscopy, ultrasonography, CT, MRI, and so on. The principles of managements were adequate drainage, infection control during acute period and radical surgery during quiescent period. Classic surgical approach consisted of complete excision of branchial lesions, dissection of recurrent laryngeal nerve and partial thyroidectomy. Selective neck dissection was applied in recurrent cases to extirpate branchial lesions, scarrings and inflammatory granuloma. Postoperatively, 1 case was with local incision infection which healed by wound care; 1 case was with temporary vocal cord paralysis which completely recovered 1 month after operation. No recurrence was found in all of 8 cases with follow-up of 13 to 42 months (median: 21 months).
  
  
  CONCLUSIONS
  CFBA relates closely anatomically with recurrent laryngeal nerve and thyroid grand. The barium esophagogram and direct laryngoscopy are the most useful diagnostic tools. CT and MRI are all beneficial to the diagnosis of CFBA. The treatment key to CFBA is the complete excision of lesion during a quiescent period after inflammatory control, together with the dissection of recurrent laryngeal nerve, partial thyroidectomy and partial resection of lamina of thyroid cartilage (if necessary), which all can decrease the risk of complications and recurrence. For recurrent cases, selective neck dissection is a safe and effective surgical procedure.
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Guangdong Academy of Medical Science, Guangzhou 510080, China. lancer_chen@21cn.com
authors.forename: Liang-si
authors.initials: LS
authors.lastname: Chen
authors.forename: Si-yi
authors.initials: SY
authors.lastname: Zhang
authors.forename: Xiao-ning
authors.initials: XN
authors.lastname: Luo
authors.forename: Xin-han
authors.initials: XH
authors.lastname: Song
authors.forename: Jian-dong
authors.initials: JD
authors.lastname: Zhan
authors.forename: Shao-hua
authors.initials: SH
authors.lastname: Chen
authors.forename: Zhong-ming
authors.initials: ZM
authors.lastname: Lu
mesh_terms: D000293:Adolescent; D000328:Adult; D001934:Branchial Region / Q000002:abnormalities*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D019767:Maxillofacial Abnormalities / Q000175:diagnosis* / Q000601:surgery*; D012009:Recurrent Laryngeal Nerve / Q000601:surgery; D012189:Retrospective Studies; D055815:Young Adult