Huang S L, Zhang B, Chen L S, Liang L, Luo X N, Lu Z M, Zhang S Y
Department of Otorhinolaryngology Head and Neck Surgery, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou 510080, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Oct 7;51(10):776-779. doi: 10.3760/cma.j.issn.1673-0860.2016.10.013.
To report rare cases of congenital neck cutaneous sinus with an orifice near the sternoclavicular joint and to investigate their origins and managements. A total of ten patients with congenital neck cutaneous sinus having an orifice near the sternoclavicular joint treated in the Guangdong General Hospital from January 2010 to June 2015 were retrospectively analyzed. There four boys and six girls, aging from 11 months to 96 months with an average of 33.4 months, and they had a common feature showing a congenital cutaneous sinus with an orifice near sternoclavicular joint. Discharge of pus from the orifice or abscess formation was commonly seen soon after infection. With bacteriological study, staphylococcus aureus was positive in five cases and klebsiella pneumonia in a case. Another orifice of fistula/sinus was not depicted in pyriform with barium swallow X-ray in five cases Ultrasound studies of three cases demonstrated anechoic (i.e., nearly black) and solid-cystic lesion near sternoclavicular joint with posterior acoustic enhancement. Magnetic resonance imaging (MRI) showed isointensity of the lesion on T1 and T2 weighted images with heterogeneous enhancement and a close relationship with sternoclavicular joint. All patients underwent laryngoscopic examination, which showed no orifice of sinus in pyriform at same side. Surgical resection of fistula/sinus was performed in all cases. The lengths of the fistula varied from 5 mm to 22 mm with an average of 11 mm. Postoperative pathological examination showed all specimens were accordance with fistula. No complications were noticed. Recurrence was not observed in the cases by following-up of 6 months to 70 months (median: 33 months). Congenital neck cutaneous sinus with orifice near the sternoclavicular joint maybe a special clinical phenotype of the fourth branchial cleft sinus with skin orifice in cervicothoracic junction. Differential diagnoses between low cervical diseases are required. The curative treatment is a complete excision during inflammatory quiescent period.
报告先天性颈部皮肤窦在胸锁关节附近有开口的罕见病例，并探讨其起源及处理方法。回顾性分析2010年1月至2015年6月在广东省人民医院治疗的10例先天性颈部皮肤窦在胸锁关节附近有开口的患者。其中男4例，女6例，年龄11个月至96个月，平均33.4个月，均有胸锁关节附近先天性皮肤窦开口这一共同特征。感染后不久常见窦口有脓性分泌物排出或形成脓肿。细菌学检查显示，5例金黄色葡萄球菌阳性，1例肺炎克雷伯菌阳性。5例经吞钡X线检查未显示梨状窝瘘管/窦的另一开口。3例超声检查显示胸锁关节附近有无回声（即几乎黑色）及实性-囊性病变，后方回声增强。磁共振成像（MRI）显示病变在T1加权像和T2加权像上呈等信号，强化不均匀，与胸锁关节关系密切。所有患者均接受喉镜检查，均未发现同侧梨状窝有窦口。所有病例均行瘘管/窦手术切除。瘘管长度5mm至22mm，平均11mm。术后病理检查显示所有标本均符合瘘管表现。未发现并发症。随访6个月至70个月（中位时间：33个月），未观察到复发病例。先天性颈部皮肤窦在胸锁关节附近开口可能是第四鳃裂窦在颈胸交界处有皮肤开口的一种特殊临床表型。需要与低位颈部疾病进行鉴别诊断。治疗方法是在炎症静止期彻底切除。
