Madana J, Yolmo Deeke, Kalaiarasi R, Gopalakrishnan S, Saxena S K, Krishnapriya S
Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605 006, India.
Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1181-5. doi: 10.1016/j.ijporl.2011.06.016. Epub 2011 Jul 18.
Acute suppurative neck infections associated with third or fourth branchial arch fistulas are frequently recurrent. Third and fourth branchial arch anomalies are much less common than those of second arch and usually present with left thyroid lobe inflammation. The authors present their experience with 15 cases of pyriform sinus fistulae (PSF) of third branchial arch origin and 3 cases of fourth arch origin, all of which presented as recurrent neck infection mainly on the left side.
A retrospective review of 18 cases of third and fourth arch fistulae treated at JIPMER from 2005 to 2010. This study includes 18 patients with PSF diagnosed by the existence of fistulous tract radiologically and intraoperatively with pathological correlation. Neck exploration with excision of tract and left hemithyroidectomy was performed in all cases.
The patients consisted of 7 males and 11 females, and the ages ranged from 3 to 15 years. All of them presented with recurrent episodes of neck infection. Investigations performed include computed tomography (CT) fistulography, barium swallow and ultrasound which were useful in delineating pyriform sinus fistulous tract preoperatively. All cases were on the left side and the fistula was identified by barium swallow in 14 cases (80%), while intraoperative and pathologic confirmation of the tract was possible in all cases (100%). Neck exploration with an emphasis on complete exposure of the recurrent laryngeal nerve and exposure of the pyriform sinus opening to facilitate complete fistulous tract excision with left hemithyroidectomy was successful in all patients. A follow up period of 1-3 years showed no recurrence.
Recurrent neck infection in a child should alert the physician to the possibility of an underlying pyriform sinus fistula of branchial origin and CT fistulography should be performed after the resolution of the neck infection to delineate the tract anatomically.
与第三或第四鳃弓瘘管相关的急性化脓性颈部感染常反复发作。第三和第四鳃弓异常比第二鳃弓异常少见得多，通常表现为左侧甲状腺叶炎症。作者介绍了他们对15例起源于第三鳃弓的梨状窦瘘（PSF）和3例起源于第四鳃弓的病例的治疗经验，所有病例均表现为主要在左侧的复发性颈部感染。
对2005年至2010年在JIPMER治疗的18例第三和第四鳃弓瘘管病例进行回顾性研究。本研究包括18例经放射学和术中证实存在瘘管并经病理证实的PSF患者。所有病例均行颈部探查，切除瘘管并进行左侧甲状腺叶切除术。
患者包括7名男性和ll名女性，年龄在3至15岁之间。他们均表现为颈部感染反复发作。所进行的检查包括计算机断层扫描（CT）瘘管造影、吞钡检查和超声检查，这些检查有助于术前描绘梨状窦瘘管。所有病例均在左侧，14例（80%）通过吞钡检查发现瘘管，而所有病例（100%）术中及病理均证实了瘘管。所有患者均成功进行了颈部探查，重点是完全暴露喉返神经和暴露梨状窦开口，以便在切除左侧甲状腺叶的同时完全切除瘘管。随访1至3年未发现复发。
儿童复发性颈部感染应提醒医生注意存在鳃源性梨状窦瘘的可能性，颈部感染消退后应进行CT瘘管造影以从解剖学上描绘瘘管。
