title: Surgery versus endoscopic cauterization in patients with third or fourth branchial pouch sinuses: A systematic review.
abstract: OBJECTIVE
  To systematically review the current literature on treatment of third and fourth branchial pouch sinuses with endoscopic cauterization, including chemocauterization and electrocauterization, in comparison to surgical treatment.
  
  
  METHODS
  PubMed, Embase, and the Cochrane Library.
  
  
  METHODS
  We conducted a systematic search. Studies reporting original study data were included. After assessing the directness of evidence and risk of bias, studies with a low directness of evidence or a high risk of bias were excluded from analysis. Cumulative success rates after initial and recurrent treatments were calculated for both methods. A meta-analysis was conducted comparing the success rate of electrocauterization and surgery.
  
  
  RESULTS
  A total of 2,263 articles were retrieved, of which seven retrospective and one prospective article were eligible for analysis. The cumulative success rate after primary treatment with cauterization ranged from 66.7% to 100%, and ranged from 77.8% to 100% after a second cauterization. The cumulative success rate after the first surgical treatment ranged from 50% to 100% and was 100% after the second surgical attempt. Meta-analysis on electrocauterization showed a nonsignificant risk ratio of 1.35 (95% confidence interval: 0.78-2.33).
  
  
  CONCLUSIONS
  The effectiveness of cauterization in preventing recurrence seems to be comparable to surgical treatment. However, we suggest endoscopic cauterization as the treatment of choice for third and fourth branchial pouch sinuses because of the lower morbidity rate.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Pediatric Otolaryngology-Head & Neck Surgery, Utrecht, the Netherlands.
authors.forename: Laura S M
authors.initials: LS
authors.lastname: Derks
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Pediatric Otolaryngology-Head & Neck Surgery, Utrecht, the Netherlands.
authors.forename: Hidde J
authors.initials: HJ
authors.lastname: Veenstra
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Pediatric Otolaryngology-Head & Neck Surgery, Utrecht, the Netherlands.
authors.forename: Karin P Q
authors.initials: KP
authors.lastname: Oomen
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Pediatric Otolaryngology-Head & Neck Surgery, Utrecht, the Netherlands.
authors.forename: Lucienne
authors.initials: L
authors.lastname: Speleman
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Pediatric Otolaryngology-Head & Neck Surgery, Utrecht, the Netherlands.|Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Inge
authors.initials: I
authors.lastname: Stegeman
mesh_terms: D001934:Branchial Region / Q000601:surgery*; D001935:Branchioma / Q000601:surgery*; D002425:Cautery / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans
keywords: Recurrent neck abscesses; endoscopic cauterization; fistula tract excision; third and fourth branchial pouch sinus