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Retrospective case review of pyriform sinus fistulae of third branchial arch origin commonly presenting as acute suppurative thyroiditis in children

  • D Yolmo (a1), J Madana (a2), R Kalaiarasi (a3), S Gopalakrishnan (a3), M Kiruba Shankar (a3) and S Krishnapriya (a3)...
Abstract
Objective:

Abnormalities of the third branchial arch are less common than those of the second arch and usually present with left thyroid lobe inflammation. This paper describes 15 cases of pyriform sinus fistulae of third branchial arch origin usually presenting as recurrent thyroid abscess on the left side.

Method:

A retrospective review of 15 cases of third arch fistulae managed 2000 and 2008, diagnosed based on histopathology and radiological evidence of a fistulous tract, and treated with fistulectomy with left hemithyroidectomy.

Results:

All patients (six boys and nine girls, aged three to 15 years) presented with recurrent low neck inflammation. Pre-operative ultrasound, computed tomography fistulography and barium swallow demonstrated a third arch fistulous tract, left-sided in all cases. The fistula was detected intra-operatively and pathologically in all cases. Surgery (successful in all cases) emphasised complete recurrent laryngeal nerve and ipsilateral pyriform sinus exposure, to facilitate tract excision, with left hemithyroidectomy. There was no recurrence over three to five years' follow up.

Conclusion:

Paediatric recurrent low neck inflammatory episodes, due to thyroidal abscess, especially left-sided, should raise suspicion of pyriform sinus fistulae.

Copyright
Corresponding author
Address for correspondence: Dr J Madana, Clinical Fellow in Head and Neck Surgery, Department of Otolaryngology and Head and Neck Surgery, National University Hospital, Singapore119074 E-mail: maddyy@gmail.com
References
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1Madana, J, Yolmo, D, Gopalakrishnan, S, Saxena, SK. Complete congenital third branchial fistula with left-sided, recurrent, suppurative thyroiditis. J Laryngol Otol 2010;124:1025–9
2Seki, N, Himi, T. Retrospective review of 13 cases of pyriform sinus fistula. Am J Otolaryngol 2007;28:55–8
3Ahuja, AT, Griffiths, JF, Roebuck, DJ, Loftus, WK, Lau, KY, Yeung, CK et al. Ultrasound and oesophagography in the management of acute suppurative thyroiditis in children associated with congenital pyriform fossa sinus. Clin Radiol 1998;53:209–11
4Myer, CM. Congenital neck masses. In: Paparella, MM, Shumrick, DA, eds. Otolaryngology: Head & Neck, 3rd edn.Philadelphia: WB Saunders, 1991;3(sec 2, part 7, ch 42):5
5Heusinger, CF. Cervical branchial fistulae of yet unobserved form [in German]. Virchows Arch Pathol Anat Physiol 1864;29:358–80
6Wenglowski, R. On cervical fistulae and cysts [In German]. Arch Clin Chir 1912;98:151208
7Kubota, M, Suita, S, Kamimura, T, Zaizen, Y. Surgical strategy for the treatment of pyriform sinus fistula. J Pediatr Surg 1997;32:34–7
8Sandborn, WD, Shafer, AD. A branchial cleft cyst of fourth pouch origin. J Pediatr Surg. 1972;7:82
9Tucker, H, Skolnick, M. Fourth branchial cleft (pharyngeal pouch) remnant. Trans Am Acad Ophthalmol Otol 1973;77:368–71
10Takai, S, Miyauchi, A, Matsuzuka, F, Kuma, K, Kosaki, G. Internal fistula as a route of infection in acute suppurative thyroiditis. Lancet 1979;i:751–2
11Miyauchi, A, Matsuzuka, F, Kuma, K, Katayama, S. Piriform sinus fistula and the ultimobranchial body. Histopathology 1992;20:221–7
12Mali, VP, Prabhakaran, K. Recurrent acute thyroid swellings because of pyriform sinus fistula. J Pediatr Surg 2008;43:2730
13Chaudhary, N, Gupta, A, Motwani, G, Kumar, S. Fistula of the fourth branchial pouch. Am J Otolaryngol 2003;24:250–2
14James, A, Stewart, C, Warrick, P, Tzifa, C, Forte, V. Branchial sinus of the piriform fossa: reappraisal of the third and fourth branchial anomalies. Laryngoscope 2007;117:1920–4
15Nicoucar, K, Giger, R, Pope, HG Jr, Jaecklin, T, Dulguerov, P. Management of congenital fourth branchial arch anomalies: a review and analysis of published cases. J Pediatr Surg 2009;44:1432–9
16Garrel, R, Jouzdani, E, Gardiner, Q, Makeieff, M, Mondain, M, Hagen, P et al. Fourth branchial pouch sinus: from diagnosis to treatment. Otolaryngol Head Neck Surg 2006;134:157–63
17Chen, EY, Inglis, AF, Ou, H, Perkins, JA, Sie, KC, Chiara, J et al. Endoscopic electrocauterization of pyriform fossa sinus tracts as definitive treatment. Int J Pediatr Otorhinolaryngol 2009;73:1151–6
18Nicoucar, K, Giger, R, Pope, HG Jr, Jaecklin, T, Dulguerov, P. Management of congenital fourth branchial arch anomalies: a review and analysis of published cases. J Pediatr Surg 2009;44:1432–9
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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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