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Surgical Atlas of pediatric otolaryngology - part 7

Một trẻ sơ sinh trình bày với một u nang cổ bên hoặc áp xe liên quan đến thỏa hiệp đường hàng không thực tế hoặc sắp xảy ra. Các đại chúng bắt chước một hygroma nang, và có thể chứa không khí hoặc tăng kích thước trong quá trình khóc hoặc Valsalva. 2. Cổ sâu tái phát nhiễm trùng. | Congenital Malformations of the Neck 507 FOURTH BRANCHIAL POUCH SINUS The fourth branchial pouch sinus is an uncommon congenital anomaly with two characteristic clinical presentations 1. Neonatal neck mass. A neonate presents with a lateral neck cyst or abscess associated with actual or impending airway compromise. The mass mimics a cystic hygroma and may contain air or increase in size during crying or Valsalva. 2. Recurrent deep neck infection. A child adolescent or occasionally an adult presents with recurrent deep neck abscess or suppurative thyroiditis despite several attempts at drainage or neck exploration. The fourth branchial pouch sinus is not a complete fistula but rather a brief internal tract originating in the piriform sinus. After exiting the pyriform apex caudal to the superior laryngeal nerve Figure 22 9 the tract descends translaryngeally under the thyroid ala to emerge beneath the inferior constrictor muscle and exit the larynx near the cricothyroid joint. Nearly all reported sinuses have been left sided. Indications Fourth branchial pouch sinus diagnosed by barium swallow sinogram when an external fistula exists or hypopharyngoscopy Suspected fourth branchial pouch sinus based on clinical history particularly unexplained recurrent deep neck infection or suppurative thyroiditis Figure 22 9 Fourth branchial pouch sinus originating in the piriform apex dashed lines caudal to the superior laryngeal nerve SLN and terminating as a small cyst in the superior pole of the thyroid gland. The sinus tract is near the recurrent laryngeal nerve RLN at the cricothyroid joint. 508 Surgical Atlas of Pediatric Otolaryngology Preparation Acutely infected sinuses are treated with antibiotics and incision and drainage if necessary definitive excision is delayed several weeks until inflammation has resolved. Perioperative antibiotics are given routinely. Equipment is available for direct microlaryngoscopy to examine the ipsilateral piriform apex for a sinus tract. .