title: Various presentations of fourth branchial pouch sinus tract during surgery.
abstract: CONCLUSIONS
  A recurrent neck abscess or acute suppurative thyroiditis should arouse suspicion of fourth branchial pouch sinus. Complete surgical excision is usually curative. The classification of sinus tract according to the area where it is emerging from the larynx may be helpful in identifying the tract during surgery.
  
  
  OBJECTIVE
  To describe our experience of the diagnosis and management of fourth branchial pouch sinus and elucidate three different emerging pathways of the sinus tract during surgery.
  
  
  METHODS
  Retrospective case series with eight patients who were diagnosed with fourth branchial pouch sinus between January 2007 and July 2011 at the First Affiliated Hospital of Zhengzhou University.
  
  
  RESULTS
  Six patients presented with recurrent neck abscess, two presented with acute suppurative thyroiditis. All patients had barium swallow and sinus tract was delineated in six cases. All eight patients underwent surgical excision of the sinus tract. Three different emerging pathways of the sinus tract were identified during surgery. The tract could penetrate the thyroid cartilage near the inferior horn, the inferior pharyngeal constrictor muscle or the cricothyroid membrane when it emerged from the larynx. The recurrent laryngeal nerve was commonly dissected to avoid inadvertent damage. Hemithyroidectomy was performed in six patients. All eight are currently asymptomatic.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, First Affiliated Hospital, Zhengzhou University, Henan, PR China.
authors.forename: Wu-Hao
authors.initials: WH
authors.lastname: Lu
authors.forename: Long
authors.initials: L
authors.lastname: Feng
authors.forename: Jian-Zhong
authors.initials: JZ
authors.lastname: Sang
authors.forename: Liang
authors.initials: L
authors.lastname: Wang
authors.forename: Lin-Lin
authors.initials: LL
authors.lastname: Yuan
authors.forename: Ling
authors.initials: L
authors.lastname: Gao
authors.forename: Wei-Hua
authors.initials: WH
authors.lastname: Lou
mesh_terms: D000038:Abscess / Q000209:etiology* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D001934:Branchial Region / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D001935:Branchioma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D013966:Thyroiditis / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult