title: Pediatric recurrent acute suppurative thyroiditis of third branchial arch origin--our experience in 17 cases.
abstract: OBJECTIVE
  To describe clinical presentations, management and treatment outcomes of 17 cases of congenital pyriform sinus fistula (PSF) of third branchial arch origin presenting as left recurrent acute suppurative thyroiditis with cervical abscess.
  
  
  METHODS
  Medical record of these 17 cases (5-males, 12-females) presented during 2009-2013 were reviewed.
  
  
  RESULTS
  Average age was 9.6 years (range 3-15 years). Fistulous opening in neck was present in 10 cases (58.8%). Average number of episode of infection from first presentation to definitive diagnosis was 3 (range 2-5). All patient had history of incision and drainage (ID) of abscess (average 2, range 1-3). All cases had barium swallow and CT scan. Sixteen cases had telescopic hypopharyngoscopy. Barium swallow and telescopic hypopharyngoscopy detected PSF in 88.23% (15/17) and 100% (16/16) cases respectively. Fourteen cases were treated by transcervical excision (TE) (fistulectomy with left hemithyroidectomy), two cases were treated by endoscopic chemical cauterization (ECC) of internal opening at pyriform sinus using silver nitrate and only ID of abscess was done in one case. Success rate of TE and ECC was 93% and 100% respectively. Recurrence in one case initially treated by TE was managed successfully by ECC.
  
  
  CONCLUSIONS
  Presence of congenital PFS should be suspected when left-sided intra-thyroidal abscess formation occurs as gland is resistant to infection. Strong clinical suspicion, barium swallow study, telescopic pharyngoscopy and CT scan are the key to diagnosis. Both TE and ECC has comparable success rate. ECC may prove a useful and equally effective method of treatment for congenital PFS in future.
authors.affiliation: Department of Otorhinolaryngology and Head-Neck Surgery, JIPMER, Puducherry, India. Electronic address: drpradipta04@gmail.com.
authors.forename: Pradipta Kumar
authors.initials: PK
authors.lastname: Parida
authors.affiliation: Department of Otorhinolaryngology and Head-Neck Surgery, JIPMER, Puducherry, India.
authors.forename: Surianarayanan
authors.initials: S
authors.lastname: Gopalakrishnan
authors.affiliation: Department of Otorhinolaryngology and Head-Neck Surgery, JIPMER, Puducherry, India.
authors.forename: Sunil Kumar
authors.initials: SK
authors.lastname: Saxena
mesh_terms: D000038:Abscess / Q000209:etiology / Q000601:surgery; D000293:Adolescent; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D001934:Branchial Region / Q000002:abnormalities; D002425:Cautery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005402:Fistula / Q000150:complications* / Q000151:congenital / Q000601:surgery; D006801:Humans; D008297:Male; D056144:Pyriform Sinus / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012835:Silver Nitrate / Q000008:administration & dosage; D013965:Thyroidectomy; D013969:Thyroiditis, Suppurative / Q000209:etiology* / Q000601:surgery
chemical_list: D000891:Anti-Infective Agents, Local; D012835:Silver Nitrate
keywords: Branchial arch; Fistula; Pyriform sinus; Thyroidectomy; Thyroiditis