Lu Wu-Hao, Feng Long, Sang Jian-Zhong, Wang Liang, Yuan Lin-Lin, Gao Ling, Lou Wei-Hua
Department of Otolaryngology-Head and Neck Surgery, First Affiliated Hospital, Zhengzhou University, Henan, PR China.
Acta Otolaryngol. 2012 May;132(5):540-5. doi: 10.3109/00016489.2011.646010. Epub 2012 Jan 11.
A recurrent neck abscess or acute suppurative thyroiditis should arouse suspicion of fourth branchial pouch sinus. Complete surgical excision is usually curative. The classification of sinus tract according to the area where it is emerging from the larynx may be helpful in identifying the tract during surgery.
To describe our experience of the diagnosis and management of fourth branchial pouch sinus and elucidate three different emerging pathways of the sinus tract during surgery.
Retrospective case series with eight patients who were diagnosed with fourth branchial pouch sinus between January 2007 and July 2011 at the First Affiliated Hospital of Zhengzhou University.
Six patients presented with recurrent neck abscess, two presented with acute suppurative thyroiditis. All patients had barium swallow and sinus tract was delineated in six cases. All eight patients underwent surgical excision of the sinus tract. Three different emerging pathways of the sinus tract were identified during surgery. The tract could penetrate the thyroid cartilage near the inferior horn, the inferior pharyngeal constrictor muscle or the cricothyroid membrane when it emerged from the larynx. The recurrent laryngeal nerve was commonly dissected to avoid inadvertent damage. Hemithyroidectomy was performed in six patients. All eight are currently asymptomatic.
复发性颈部脓肿或急性化脓性甲状腺炎应引起对第四鳃裂窦的怀疑。完整的手术切除通常可治愈。根据窦道从喉部发出的区域对其进行分类，可能有助于在手术中识别该窦道。
描述我们对第四鳃裂窦的诊断和治疗经验，并阐明手术中窦道的三种不同发出途径。
回顾性病例系列研究，纳入2007年1月至2011年7月在郑州大学第一附属医院被诊断为第四鳃裂窦的8例患者。
6例患者表现为复发性颈部脓肿，2例表现为急性化脓性甲状腺炎。所有患者均行吞钡检查，6例明确了窦道情况。所有8例患者均接受了窦道手术切除。手术中发现窦道有三种不同的发出途径。当窦道从喉部发出时，可穿透下角附近的甲状软骨、咽下缩肌或环甲膜。术中常需解剖喉返神经以避免意外损伤。6例患者行甲状腺半切除术。目前所有8例患者均无症状。
