title: Management of third branchial pouch anomalies - an evolution of a minimally invasive technique.
abstract: OBJECTIVE
  The management of third branchial pouch anomalies has evolved in recent times with the popularisation of the endoscopic diathermy technique to sclerose the pyriform fossa sinus opening. We present our experience in managing 3 children with third branchial pouch anomalies and propose a minimally invasive management algorithm avoiding open neck surgery.
  
  
  METHODS
  Retrospective case review of 3 patients including demographics, mode of presentation, investigations, management and complications.
  
  
  RESULTS
  Three children, two male and one female of mean age 9.6 years presented with painful left anterior neck swelling. Axial neck imaging showed a superficial abscess with air locules and a sinus tract leading towards the left pharynx. Diagnosis was confirmed by endoscopic examination of the pyriform fossa revealing a sinus opening. Two patients underwent open excision; one combined with diathermy to the sinus opening. The last patient was diagnosed at his initial presentation and managed with endoscopic diathermy of the sinus opening combined with percutaneous needle aspiration of the neck abscess at the same sitting. One patient had two recurrences, the first after initial open surgery and the second after the first cautery. Two patients developed temporary hoarseness after the procedure, which resolved within two weeks. All patients were free from recurrences at follow-up.
  
  
  CONCLUSIONS
  Introduction of the technique of endoscopic diathermy to the pyriform fossa sinus opening in children with third branchial pouch anomalies has revolutionised their management avoiding open and potentially morbid surgery. Our algorithm takes this further by advocating percutaneous needle aspiration of the infective component and performing diathermy to the sinus opening at the first presentation.
authors.affiliation: Department of Ear, Nose and Throat, St. George's Hospital, Blackshaw Road, London SW17 0QT, United Kingdom.
authors.forename: Phui Yee
authors.initials: PY
authors.lastname: Wong
authors.affiliation: Department of Ear, Nose and Throat, St. George's Hospital, Blackshaw Road, London SW17 0QT, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Moore
authors.affiliation: Department of Ear, Nose and Throat, St. George's Hospital, Blackshaw Road, London SW17 0QT, United Kingdom. Electronic address: hamiddaya@ent4kids.co.uk.
authors.forename: Hamid
authors.initials: H
authors.lastname: Daya
mesh_terms: D000293:Adolescent; D001934:Branchial Region / Q000002:abnormalities* / Q000601:surgery*; D002648:Child; D004564:Electrocoagulation / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007828:Laryngoscopy / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D056144:Pyriform Sinus / Q000002:abnormalities / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D016896:Treatment Outcome
keywords: Anterior neck swelling; Endoscopic cauterization; Minimally invasive management; Sinus opening left pyriform fossa; Third branchial pouch anomaly