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

Published online by Cambridge University Press:  25 May 2012

D Yolmo ,
J Madana ,
R Kalaiarasi ,
S Gopalakrishnan ,
M Kiruba Shankar  and
S Krishnapriya
D Yolmo
Affiliation:
Department of Otolaryngology – Head & Neck Surgery, Darjeeling District Hospital, West Bengal, India
J Madana*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, National University Hospital, Singapore
R Kalaiarasi
Affiliation:
Department of Otolaryngology – Head & Neck Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
S Gopalakrishnan
Affiliation:
Department of Otolaryngology – Head & Neck Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
M Kiruba Shankar
Affiliation:
Department of Otolaryngology – Head & Neck Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
S Krishnapriya
Affiliation:
Department of Otolaryngology – Head & Neck Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
*
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
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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.

Keywords

Branchial ArchFistulaThyroidectomyPyriform SinusThyroiditis
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 7 , July 2012 , pp. 737 - 742
Copyright
Copyright © JLO (1984) Limited 2012

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References

1Madana, J, Yolmo, D, Gopalakrishnan, S, Saxena, SK. Complete congenital third branchial fistula with left-sided, recurrent, suppurative thyroiditis. J Laryngol Otol 2010;124:1025–9CrossRefGoogle ScholarPubMed
2Seki, N, Himi, T. Retrospective review of 13 cases of pyriform sinus fistula. Am J Otolaryngol 2007;28:55–8CrossRefGoogle ScholarPubMed
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;53:209–11CrossRefGoogle ScholarPubMed
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):5Google Scholar
5Heusinger, CF. Cervical branchial fistulae of yet unobserved form [in German]. Virchows Arch Pathol Anat Physiol 1864;29:358–80CrossRefGoogle Scholar
6Wenglowski, R. On cervical fistulae and cysts [In German]. Arch Clin Chir 1912;98:151–208Google Scholar
7Kubota, M, Suita, S, Kamimura, T, Zaizen, Y. Surgical strategy for the treatment of pyriform sinus fistula. J Pediatr Surg 1997;32:34–7CrossRefGoogle ScholarPubMed
8Sandborn, WD, Shafer, AD. A branchial cleft cyst of fourth pouch origin. J Pediatr Surg. 1972;7:82CrossRefGoogle ScholarPubMed
9Tucker, H, Skolnick, M. Fourth branchial cleft (pharyngeal pouch) remnant. Trans Am Acad Ophthalmol Otol 1973;77:368–71Google ScholarPubMed
10Takai, S, Miyauchi, A, Matsuzuka, F, Kuma, K, Kosaki, G. Internal fistula as a route of infection in acute suppurative thyroiditis. Lancet 1979;i:751–2CrossRefGoogle Scholar
11Miyauchi, A, Matsuzuka, F, Kuma, K, Katayama, S. Piriform sinus fistula and the ultimobranchial body. Histopathology 1992;20:221–7CrossRefGoogle ScholarPubMed
12Mali, VP, Prabhakaran, K. Recurrent acute thyroid swellings because of pyriform sinus fistula. J Pediatr Surg 2008;43:27–30CrossRefGoogle ScholarPubMed
13Chaudhary, N, Gupta, A, Motwani, G, Kumar, S. Fistula of the fourth branchial pouch. Am J Otolaryngol 2003;24:250–2CrossRefGoogle ScholarPubMed
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;117:1920–4CrossRefGoogle ScholarPubMed
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;44:1432–9CrossRefGoogle ScholarPubMed
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;134:157–63CrossRefGoogle ScholarPubMed
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;73:1151–6CrossRefGoogle ScholarPubMed
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;44:1432–9CrossRefGoogle ScholarPubMed