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Treatment of piriform fossa sinuses with monopolar diathermy
1Department of Otolaryngology, Great Ormond Street Hospital for Children, London, UK.
Insights
Endoscopic diathermy effectively treats congenital third and fourth branchial pouch sinuses (recurrent neck abscesses) by closing the internal opening. This minimally invasive approach offers a safe and successful alternative or adjunct to traditional surgery.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Endoscopic Surgery
Background:
- Congenital third and fourth branchial pouch sinuses are rare causes of recurrent neck abscesses in children.
- These sinuses feature an internal opening within the piriform fossa.
- Conventional treatment involves complete surgical excision of the sinus tract.
Observation:
- A retrospective review of four pediatric cases with piriform fossa sinus was conducted.
- Monopolar diathermy was applied endoscopically to the internal sinus opening.
- Three patients underwent diathermy for recurrent abscesses post-excision; one had simultaneous excision and diathermy.
Findings:
- Endoscopic diathermy of the piriform fossa sinus opening resulted in no serious complications.
- No recurrence was observed during follow-up periods ranging from 9 to 27 months.
- This technique proved effective in obliterating the internal sinus opening.
Implications:
- Endoscopic diathermy is a safe and effective management option for piriform fossa sinuses.
- It can be used as an alternative to or adjunct with external surgical tract excision.
- This approach offers a minimally invasive solution for recurrent neck abscesses in children.
Introduction:
Embryological remnants of third or fourth branchial pouches are a rare but important cause of recurrent neck abscesses in children. They are characterised by an internal opening in the piriform fossa. Traditional management involves surgical excision of the entire tract. We present our experience with the use of monopolar diathermy applied to the internal sinus opening as a treatment modality for this condition.
Materials And Methods:
A retrospective, case report review was performed.
Results:
Four cases of piriform fossa sinus were treated with monopolar diathermy to the sinus opening via an endoscopic approach. The first three cases were treated in this way for recurrence, following external tract excision, while the fourth case had simultaneous excision of the tract and diathermy to the piriform fossa opening. There were no serious complications and no recurrence within a follow-up period ranging from nine to 27 months.
Discussion:
Obliteration of the internal opening of these sinuses by endoscopic diathermy is a safe and effective management option for this condition, either as an alternative to or as an adjunct to external surgical excision of the tract.
