Contencin P, Augui O, de Gaudemar I, Helardot P
Unité d'ORL et de Chirurgie Cervico-Faciale, Hôpital Saint-Vincent-de-Paul, Faculté Cochin-Port-Royal, Paris.
Ann Chir. 1997;51(1):76-81.
Recurrent "abscesses" occurring in the thyroid area in children are due to branchial anomalies. Their origin is located close to the oesophageal inlet at the apex of the lateral hypopharyngeal process: the pyriform sinus. The key for the diagnosis comes from laryngohypopharyngoscopy. The true original anomaly is a controversial topic: the persistence of a canal originating from the 3rd or 4th branchial pouch. Anyhow, these anomalies sometimes build tracts or cysts in the deeper parts of the neck, down to the supraclavicular or thoracic areas. Most often, they are limited to the soft tissues surrounding the left thyroid lobe. In these cases, no cyst wall can be found. The 3 cases reported here allow us to ascertain that a pharyngeal infection is the trigger for the neck abscess. Furthermore, a mucosal opening can be the only found anomaly. After recovery from the infectious process, these anomalies have to be treated by a mucosal suture of the pyriform sinus. The recurrent laryngeal nerve should be first discovered and the removal of a small piece of cartilage can be required. If these diagnostic and therapeutic procedures are used at the first infectious episode, they may prevent the occurrence of repeated thyroid "abscesses" in children.
儿童甲状腺区域反复出现的“脓肿”是由鳃裂异常引起的。其起源位于下咽外侧突顶端靠近食管入口处：梨状窦。诊断的关键在于喉下咽镜检查。真正的原始异常是一个有争议的话题：源自第三或第四鳃囊的管道持续存在。无论如何，这些异常有时会在颈部深部形成管道或囊肿，直至锁骨上或胸部区域。最常见的是，它们局限于左甲状腺叶周围的软组织。在这些情况下，找不到囊肿壁。这里报告的3例病例让我们确定咽部感染是颈部脓肿的触发因素。此外，黏膜开口可能是唯一发现的异常。在感染过程恢复后，这些异常必须通过梨状窦黏膜缝合进行治疗。应首先找到喉返神经，可能需要切除一小片软骨。如果在首次感染发作时采用这些诊断和治疗程序，可能会防止儿童反复出现甲状腺“脓肿”。
