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[Recurrent pseudothyroiditis and cervical abscess. The fourth branchial pouch's role. Apropos of 16 cases]
P Contencin1, C Grosskopf-Aumont, L Gilain
1Service d'Otorhinolaryngologie, Hôpital Robert-Debré, Paris.
Insights
Inflammatory neck swelling in children can stem from unrecognized hypopharyngeal cysts and ducts, causing recurrent infections. Surgical excision of these "internal fistulas" is crucial for preventing relapses.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Medical Imaging
Context:
- Recurrent cervical abscesses and pseudothyroiditis in children often present diagnostic challenges.
- Traditional treatments like antibiotics and drainage may fail due to underlying unrecognized pathology.
Purpose:
- To highlight the significance of hypopharyngeal cysts and ducts as a cause of recurrent neck inflammation in pediatric patients.
- To emphasize the diagnostic utility of hypopharyngoscopy for identifying these internal fistulas.
Summary:
- This pathology, involving hypopharyngeal "cysts" and ducts, leads to relapsing suppurative conditions in children.
- Radiography can reveal fistulas, but diagnosis is confirmed by hypopharyngoscopy, visualizing the mucous opening in the pyriform sinus.
- The condition's left-sided prevalence and nerve proximity suggest a possible origin from the 4th branchial pouch.
Impact:
- Accurate diagnosis through hypopharyngoscopy allows for targeted treatment, preventing recurrent infections.
- Complete surgical excision of the identified fistula is the definitive treatment, ensuring a cure and avoiding relapse.
- This understanding improves management strategies for challenging pediatric neck masses and infections.
Abstract:
Among the causes of inflammatory swelling of the neck in children, the "cysts" and ducts joining in the hypopharynx deserve being individualized. This unrecognized pathology is indeed responsible for suppurative pseudothyroiditis or cervical abscesses relapsing in spite of adequate antibiotic treatment and incision-drainage. X-ray films may help as they often show the fistula. Diagnosis relies on hypopharyngoscopy. This investigation only may assess the origin of this "internal fistula" by showing the mucous opening of the bottom of the pyriform sinus, from which sometimes springs some pus when pressing the neck. The clear left predominance of this canal and its junction between the superior and inferior laryngeal nerves suggest that its origin could be the 4th branchial pouch. Its treatment consists of complete surgical excision, which avoids relapses.