A novel surgical management of hypopharyngeal branchial anomalies.
OBJECTIVE
To review our experience treating hypopharyngeal branchial anomalies utilizing an open transcervical approach that: (1) includes recurrent laryngeal nerve (RLN) monitoring and identification if needed; (2) resection of tract if present; and (3) a superiorly based sternothyroid muscle flap for closure.


METHODS
A retrospective chart review was performed to identify all patients at a tertiary level children's hospital with branchial anomalies from 2005 to 2014. The clinical presentation, evaluation, treatment and outcome were analyzed for those patients with hypopharyngeal branchial anomalies.


RESULTS
Forty-seven patients who underwent excision of branchial anomalies with a known origin were identified. Thirteen patients had hypopharyngeal branchial anomalies. Six of these patients were treated by the authors of this study and are the focus of this analysis. All six underwent an open transcervical procedure with a sternothyroid muscle flap closure of a piriform sinus opening over a nine year period. Definitive surgery included a microlaryngoscopy and an open transcervical approach to close a fistula between the piriform sinus and neck with recurrent laryngeal nerve monitoring or dissection. A superiorly based sternothyroid muscle flap was used to close the sinus opening. There were no recurrences, recurrent laryngeal nerve injuries or other complications from these procedures.


CONCLUSIONS
This study supports complete surgical extirpation of the fistula tract using an open cervical approach, recurrent laryngeal nerve monitoring or identification, and rotational muscle flap closure to treat patients with hypopharyngeal branchial anomalies.
Dubuque ENT Head and Neck Surgery, Dubuque, IA, USA.
Daniel J
DJ
Givens
Department of Surgery, Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA.
Luke O
LO
Buchmann
Department of Surgery, Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA. Electronic address: albert.park@imail.org.
Albert H
AH
Park
D000293:Adolescent; D001934:Branchial Region / Q000002:abnormalities*; D002648:Child; D002675:Child, Preschool; D004210:Dissection / Q000379:methods*; D005260:Female; D006801:Humans; D007013:Hypopharynx / Q000002:abnormalities*; D007223:Infant; D007231:Infant, Newborn; D064795:Intraoperative Neurophysiological Monitoring; D007828:Laryngoscopy; D008297:Male; D009334:Neck Muscles; D012009:Recurrent Laryngeal Nerve; D016156:Respiratory Tract Fistula / Q000209:etiology / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D013524:Surgical Flaps; D013965:Thyroidectomy
Branchial sinus; Neck abscess; Neck dissection; Neck mass; Type 3; Type 4