Chen Liang-si, Zhang Si-yi, Luo Xiao-ning, Song Xin-han, Zhan Jian-dong, Chen Shao-hua, Lu Zhong-ming
Department of Otorhinolaryngology Head and Neck Surgery, Guangdong Academy of Medical Science, Guangzhou 510080, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2010 Oct;45(10):835-8.
To discuss the anatomic features, clinical presentations, diagnosis, differentiations and treatments of congenital fourth branchial anomaly(CFBA).
The clinical data of 8 patients with CFBA were retrospectively analyzed.
Of the 8 patients aging from 27 to 300 months (median age: 114 months), 4 male and 4 female; 3 untreated previously and 5 recurrent. All lesions, including 1 cyst, 3 sinus (with internal opening) and 4 fistula, located in the left necks. Three patients presented acute suppurative thyroiditis, 4 deep neck abscesses, and 1 neck lump. Preoperative examinations included barium esophagogram, direct laryngoscopy, ultrasonography, CT, MRI, and so on. The principles of managements were adequate drainage, infection control during acute period and radical surgery during quiescent period. Classic surgical approach consisted of complete excision of branchial lesions, dissection of recurrent laryngeal nerve and partial thyroidectomy. Selective neck dissection was applied in recurrent cases to extirpate branchial lesions, scarrings and inflammatory granuloma. Postoperatively, 1 case was with local incision infection which healed by wound care; 1 case was with temporary vocal cord paralysis which completely recovered 1 month after operation. No recurrence was found in all of 8 cases with follow-up of 13 to 42 months (median: 21 months).
CFBA relates closely anatomically with recurrent laryngeal nerve and thyroid grand. The barium esophagogram and direct laryngoscopy are the most useful diagnostic tools. CT and MRI are all beneficial to the diagnosis of CFBA. The treatment key to CFBA is the complete excision of lesion during a quiescent period after inflammatory control, together with the dissection of recurrent laryngeal nerve, partial thyroidectomy and partial resection of lamina of thyroid cartilage (if necessary), which all can decrease the risk of complications and recurrence. For recurrent cases, selective neck dissection is a safe and effective surgical procedure.
探讨先天性第四鳃裂畸形（CFBA）的解剖学特征、临床表现、诊断、鉴别诊断及治疗方法。
回顾性分析8例CFBA患者的临床资料。
8例患者年龄27至300个月（中位年龄：114个月），男4例，女4例；3例未经治疗，5例复发。所有病变包括1例囊肿、3例窦道（有内口）和4例瘘管，均位于左侧颈部。3例表现为急性化脓性甲状腺炎，4例为颈部深部脓肿，1例为颈部肿块。术前检查包括食管钡餐造影、直接喉镜检查、超声检查、CT、MRI等。治疗原则为急性期充分引流、控制感染，静止期行根治性手术。经典手术方法包括完整切除鳃裂病变、解剖喉返神经和部分甲状腺切除术。复发病例采用选择性颈清扫术切除鳃裂病变、瘢痕组织和炎性肉芽肿。术后，1例局部切口感染，经伤口护理愈合；1例出现暂时性声带麻痹，术后1个月完全恢复。8例患者随访13至42个月（中位：21个月），均无复发。
CFBA在解剖学上与喉返神经和甲状腺关系密切。食管钡餐造影和直接喉镜检查是最有用的诊断工具。CT和MRI均有助于CFBA的诊断。CFBA的治疗关键是在炎症控制后的静止期完整切除病变，同时解剖喉返神经、部分甲状腺切除术和必要时部分切除甲状软骨板，这些均可降低并发症和复发风险。对于复发病例，选择性颈清扫术是一种安全有效的手术方法。
