Surgical treatment of fourth branchial apparatus anomalies: a case series study

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(2020) 49:79

ORIGINAL RESEARCH ARTICLE

Open Access

Surgical treatment of fourth branchial apparatus anomalies: a case series study Wan-Xin Li1, Yanbo Dong1, Aobo Zhang1, Jun Tian1, Cheng Lu1, Jean Pierre Jeannon2 and Liangfa Liu1*

Abstract Background: Fourth branchial apparatus anomalies, are rare clinical entities, and present as complex cysts, sinuses and fistulae in the neck that can be difficult to manage. Methods: This is a retrospective review of a series of consecutive patients with fourth branchial apparatus anomalies treated at Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, from Apr 2014 to Nov 2019. Results: Ten patients with fourth branchial apparatus anomalies were identified, including 8 patients with fourth branchial fistula, and 2 patients with fourth branchial pouch sinus. There were 6 female patients and 4 male patients. Their age was from 6 years old to 39 years old (average age 20.4 years old, median age was 21 years old). All 8 fistulae were on the left side, while 2 pouch sinuses were both on the right side. Preoperative examination with fiberoptic laryngoscope, barium swallow X-ray, CT or MRI identified internal orifice at pyriform fossa apex in 8 (80%) patients. All patients underwent challenging surgical resection by the senior author. Intra-operative direct laryngoscope confirmed or identified internal orifice in 9 (90%) patients. The tracts were all followed to the vicinity of inferior cornu of the thyroid cartilage and the cricothyroid space. Complete resection of cervical lesions and their attachment to hypopharynx were achieved in 9 cases. No complication occurred. One recurrence was detected, in the only patient whose internal orifice could not be located pre- or intra-operatively, and the hypopharyngeal attachment could not be removed. Conclusions: Direct laryngoscopy under general anesthesia is a reliable method of diagnosis for the fourth branchial apparatus anomalies. Complete surgical removal of fourth branchial apparatus anomalies, including their hypopharyngeal attachment, is the treatment of choice, and the key to prevent recurrence. Keywords: Fourth branchial apparatus anomalies, Complete surgical excision, Direct laryngoscope, Superior laryngeal nerve, Pyriform fossa apex

Background Branchial anomalies are congenital conditions which results as a consequence of aberrant embryonic development of the branchial apparatus. A spectrum of conditions can result due to failure of the coordinated branchial alignment which include branchial cysts, fistulae, and sinuses. These may occur * Correspondence: [email protected] 1 Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, 95th Yong’an Road, Xicheng District, Beijing 100050, China Full list of author information is available at the end of the article

in any age, but the first and second decades of life are the most common [1]. Anomalies of the second branchial apparatus are the most commonly seen branchial