Watson G J, Nichani J R, Rothera M P, Bruce I A
Royal Manchester Children's Hospital, United Kingdom.
Int J Pediatr Otorhinolaryngol. 2013 May;77(5):766-9. doi: 10.1016/j.ijporl.2013.02.007. Epub 2013 Mar 9.
Fourth branchial arch anomalies represent <1% of all branchial anomalies and present as recurrent neck infections or suppurative thyroiditis. Traditionally, management has consisted of treatment of the acute infection followed by hemithyroidectomy, surgical excision of the tract and obliteration of the opening in the pyriform fossa. Recently, it has been suggested that endoscopic obliteration of the sinus tract alone using laser, chemo or electrocautery is a viable alternative to open surgery.
To determine the results of endoscopic obliteration of fourth branchial arch fistulae in children in our institute.
Retrospective case note review of all children undergoing endoscopic treatment of fourth branchial arch anomalies in the last 7 years at the Royal Manchester Children's Hospital. Patient demographics, presenting symptoms, investigations and surgical technique were analysed. The primary and secondary outcome measures were resolution of recurrent infections and incidence of surgical complications, respectively.
In total 5 cases were identified (4 females and 1 male) aged between 3 and 12 years. All presented with recurrent left sided neck abscesses. All children underwent a diagnostic laryngo-tracheo-bronchoscopy which identified a sinus in the apex of the left pyriform fossa. This was obliterated using electrocautery in 1 patient, CO₂ laser/Silver Nitrate chemocautery in 2 patients and Silver Nitrate chemocautery in a further 2 patients. There were no complications and no recurrences over a mean follow-up period of 25 months (range 11-41 months).
Endoscopic obliteration of pyriform fossa sinus is a safe method for treating fourth branchial arch anomalies with no recurrence.
第四鳃弓异常占所有鳃弓异常的比例不到1%，表现为复发性颈部感染或化脓性甲状腺炎。传统上，治疗方法包括先治疗急性感染，然后进行半甲状腺切除术、瘘管的手术切除以及梨状窝开口的封闭。最近，有人提出仅使用激光、化学药物或电灼进行内镜下瘘管封闭是开放手术的一种可行替代方法。
确定我院儿童第四鳃弓瘘管内镜下封闭的效果。
对皇家曼彻斯特儿童医院过去7年接受第四鳃弓异常内镜治疗的所有儿童进行回顾性病例记录审查。分析患者的人口统计学特征、症状表现、检查和手术技术。主要和次要结局指标分别为复发性感染的缓解情况和手术并发症的发生率。
共确定5例（4例女性，1例男性），年龄在3至12岁之间。所有患者均表现为左侧复发性颈部脓肿。所有儿童均接受了诊断性喉气管支气管镜检查，发现左侧梨状窝尖部有一个窦道。1例患者使用电灼封闭，2例患者使用二氧化碳激光/硝酸银化学烧灼封闭，另外2例患者使用硝酸银化学烧灼封闭。平均随访25个月（范围11 - 41个月），无并发症发生，也无复发。
内镜下封闭梨状窝窦是治疗第四鳃弓异常的一种安全方法，且无复发。
