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Retrospective case review of pyriform sinus fistulae of third branchial arch origin commonly presenting as acute suppurative thyroiditis in children

Published online by Cambridge University Press:  25 May 2012

D Yolmo ,
J Madana ,
R Kalaiarasi ,
S Gopalakrishnan ,
M Kiruba Shankar  and
S Krishnapriya
D Yolmo
Affiliation:
Department of Otolaryngology – Head & Neck Surgery, Darjeeling District Hospital, West Bengal, India
J Madana*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, National University Hospital, Singapore
R Kalaiarasi
Affiliation:
Department of Otolaryngology – Head & Neck Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
S Gopalakrishnan
Affiliation:
Department of Otolaryngology – Head & Neck Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
M Kiruba Shankar
Affiliation:
Department of Otolaryngology – Head & Neck Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
S Krishnapriya
Affiliation:
Department of Otolaryngology – Head & Neck Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
*
Address for correspondence: Dr J Madana, Clinical Fellow in Head and Neck Surgery, Department of Otolaryngology and Head and Neck Surgery, National University Hospital, Singapore119074 E-mail: maddyy@gmail.com
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Abstract

Objective:

Abnormalities of the third branchial arch are less common than those of the second arch and usually present with left thyroid lobe inflammation. This paper describes 15 cases of pyriform sinus fistulae of third branchial arch origin usually presenting as recurrent thyroid abscess on the left side.

Method:

A retrospective review of 15 cases of third arch fistulae managed 2000 and 2008, diagnosed based on histopathology and radiological evidence of a fistulous tract, and treated with fistulectomy with left hemithyroidectomy.

Results:

All patients (six boys and nine girls, aged three to 15 years) presented with recurrent low neck inflammation. Pre-operative ultrasound, computed tomography fistulography and barium swallow demonstrated a third arch fistulous tract, left-sided in all cases. The fistula was detected intra-operatively and pathologically in all cases. Surgery (successful in all cases) emphasised complete recurrent laryngeal nerve and ipsilateral pyriform sinus exposure, to facilitate tract excision, with left hemithyroidectomy. There was no recurrence over three to five years' follow up.

Conclusion:

Paediatric recurrent low neck inflammatory episodes, due to thyroidal abscess, especially left-sided, should raise suspicion of pyriform sinus fistulae.

Keywords

Branchial ArchFistulaThyroidectomyPyriform SinusThyroiditis
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 7 , July 2012 , pp. 737 - 742
Copyright
Copyright © JLO (1984) Limited 2012

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