title: [Fourth branchial pouch sinus of children: from diagnosis to techniques and technology of surgical operation].
abstract: OBJECTIVE
  To clarify the correct diagnostic methods of FBPS of children, and to explore techniques and technology of surgical operation aim to complete excision of sinus tract and preservation of the recurrent laryngeal nerve through analyzing the clinical characteristics and the characteristics of open neck surgery in FBPS of children.
  
  
  METHODS
  Clinical materials of 6 children FBPS with internal pyriform sinus were retrospectively analyzed, and literatures were studied to explore the appropriate surgical management of children FBPS; lesions of 6 patients were completely dissected by open neck surgery with the help of di-direction catheterization revealing the tract of fistula, and the openings of the fistula to pyriform apex were cauterized by monopolar coagulation at the end of the procedure; all 6 cases were with systematic endoscopic follow-up.
  
  
  RESULTS
  All cases of 6 children patients were cured by open neck surgery, no recurrence of clinical symptoms were observed during a mean follow-up of 14 months (1-3 years); 2 cases were diagnosed with an "anatomical" relapse (persistence of the sinus tract orifice without clinical symptoms) at the follow-up endoscopy(at 3 and 4 months after surgery); all 6 cases had no complication of laryngeal paralysis.
  
  
  CONCLUSIONS
  The children patients presenting recurrent acute suppurative thyroiditis and deep neck abscess of anterior area in the lower part of neck, especially locating left neck, should be considered as the diagnosis of FBPS. also the same as confirmed by enhanced neck CT scan and direct laryngoscopy. Patients with identification of internal pyriform sinus and Betz fold by direct laryngoscopy, and with identification of fistula which passes through the cricothyroid membrane beneath the superior laryngeal nerve can be confirmed FBPS. Completely dissection of sinus tract by open neck surgery was the effective management of children FBPS and di direction catheterization aids to reveal and identify the tract of fistula. Resection of the posterior part of the thyroid cartilage ala can be useful to aid exposure and preservation of the recurrent laryngeal nerve; but co-excision of a portion of the upper of the thyroid gland aids to the entire dissection of lesions. In addition, cauterizing the opening of the fistula to pyriform apex may be useful to obliterate the internal opening of pyriform sinus.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, the First People's Hospital of Xiangyang, Xiangyang, 441000, China. margret7822@sina.com
authors.forename: Ting
authors.initials: T
authors.lastname: Zhu
authors.forename: Younghong
authors.initials: Y
authors.lastname: Dong
authors.forename: Huazhang
authors.initials: H
authors.lastname: Tan
authors.forename: Yonghong
authors.initials: Y
authors.lastname: Zhang
authors.forename: Shihong
authors.initials: S
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D001934:Branchial Region / Q000002:abnormalities*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005402:Fistula / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008297:Male; D009333:Neck; D012189:Retrospective Studies