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Stridor as a presentation of fourth branchial pouch sinus
K Nathan1, Y Bajaj, C G Jephson
1Department of Paediatric Otolaryngology, Great Ormond Street Hospital, London, UK.
The Journal of Laryngology and Otology
|February 9, 2012
Summary
A rare fourth branchial pouch sinus caused stridor in a neonate. Successful aspiration and treatment led to complete resolution of symptoms and normal feeding, demonstrating effective management of this congenital anomaly.
Area of Science:
- Congenital anomalies
- Embryology
- Pediatric surgery
Background:
- Fourth branchial anomalies are rare congenital malformations.
- They result from incomplete involution of the embryonic fourth branchial cleft.
- Clinical presentations include neck sinuses, cysts, or abscesses, often in childhood.
Observation:
- A neonate presented with stridor, a critical airway obstruction symptom.
- Diagnostic evaluation revealed a fourth branchial pouch sinus without external neck swelling.
- Imaging confirmed a pharyngeal swelling containing air and fluid.
Findings:
- Microlaryngobronchoscopy identified a pharyngeal wall swelling and sinus in the pyriform fossa.
- Aspiration of the swelling and treatment of the fourth branchial pouch were performed.
- Follow-up endoscopy showed complete resolution of the pharyngeal swelling.
Implications:
- This case highlights stridor as a presenting symptom of fourth branchial pouch anomalies in neonates.
- Prompt diagnosis and minimally invasive treatment (aspiration) can lead to successful outcomes.
- Effective management ensures resolution of airway symptoms and normal feeding, preventing long-term complications.
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