title: Recurrent neck infection with branchial arch fistula in children.
abstract: OBJECTIVE
  Acute suppurative neck infections associated with third or fourth branchial arch fistulas are frequently recurrent. Third and fourth branchial arch anomalies are much less common than those of second arch and usually present with left thyroid lobe inflammation. The authors present their experience with 15 cases of pyriform sinus fistulae (PSF) of third branchial arch origin and 3 cases of fourth arch origin, all of which presented as recurrent neck infection mainly on the left side.
  
  
  METHODS
  A retrospective review of 18 cases of third and fourth arch fistulae treated at JIPMER from 2005 to 2010. This study includes 18 patients with PSF diagnosed by the existence of fistulous tract radiologically and intraoperatively with pathological correlation. Neck exploration with excision of tract and left hemithyroidectomy was performed in all cases.
  
  
  RESULTS
  The patients consisted of 7 males and 11 females, and the ages ranged from 3 to 15 years. All of them presented with recurrent episodes of neck infection. Investigations performed include computed tomography (CT) fistulography, barium swallow and ultrasound which were useful in delineating pyriform sinus fistulous tract preoperatively. All cases were on the left side and the fistula was identified by barium swallow in 14 cases (80%), while intraoperative and pathologic confirmation of the tract was possible in all cases (100%). Neck exploration with an emphasis on complete exposure of the recurrent laryngeal nerve and exposure of the pyriform sinus opening to facilitate complete fistulous tract excision with left hemithyroidectomy was successful in all patients. A follow up period of 1-3 years showed no recurrence.
  
  
  CONCLUSIONS
  Recurrent neck infection in a child should alert the physician to the possibility of an underlying pyriform sinus fistula of branchial origin and CT fistulography should be performed after the resolution of the neck infection to delineate the tract anatomically.
authors.affiliation: Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605 006, India. maddyy@gmail.com
authors.forename: J
authors.initials: J
authors.lastname: Madana
authors.forename: Deeke
authors.initials: D
authors.lastname: Yolmo
authors.forename: R
authors.initials: R
authors.lastname: Kalaiarasi
authors.forename: S
authors.initials: S
authors.lastname: Gopalakrishnan
authors.forename: S K
authors.initials: SK
authors.lastname: Saxena
authors.forename: S
authors.initials: S
authors.lastname: Krishnapriya
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy; D001934:Branchial Region / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005402:Fistula / Q000000981:diagnostic imaging* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009333:Neck; D056144:Pyriform Sinus / Q000000981:diagnostic imaging / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D013965:Thyroidectomy / Q000379:methods; D013966:Thyroiditis / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents