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[Recurrent thyroid abscess in children and malformations of the pyriform sinus]
P Contencin1, O Augui, I de Gaudemar
1Unité d'ORL et de Chirurgie Cervico-Faciale, Hôpital Saint-Vincent-de-Paul, Faculté Cochin-Port-Royal, Paris.
Insights
Recurrent neck abscesses in children often stem from branchial anomalies, specifically the pyriform sinus. Early diagnosis via laryngohypopharyngoscopy and surgical repair can prevent recurring infections.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Developmental Biology
Background:
- Recurrent thyroid area abscesses in children are frequently misdiagnosed.
- These abscesses are often linked to congenital branchial anomalies.
Observation:
- Branchial anomalies, particularly those involving the pyriform sinus, are the underlying cause of recurrent neck abscesses in children.
- Infections trigger these abscesses, which may present as tracts or cysts, often near the left thyroid lobe.
- A mucosal opening in the pyriform sinus can be the sole identified anomaly.
Findings:
- Laryngohypopharyngoscopy is crucial for diagnosing these branchial anomalies.
- The persistence of a canal from the 3rd or 4th branchial pouch is a suspected origin.
- Pharyngeal infection acts as the primary trigger for neck abscess development.
Implications:
- Surgical intervention, including mucosal suture of the pyriform sinus and recurrent laryngeal nerve identification, is recommended after infection resolution.
- Timely diagnosis and treatment can prevent recurrent thyroid abscesses in pediatric patients.
- Understanding these anomalies aids in effective management and improved patient outcomes.
Abstract:
Recurrent "abscesses" occurring in the thyroid area in children are due to branchial anomalies. Their origin is located close to the oesophageal inlet at the apex of the lateral hypopharyngeal process: the pyriform sinus. The key for the diagnosis comes from laryngohypopharyngoscopy. The true original anomaly is a controversial topic: the persistence of a canal originating from the 3rd or 4th branchial pouch. Anyhow, these anomalies sometimes build tracts or cysts in the deeper parts of the neck, down to the supraclavicular or thoracic areas. Most often, they are limited to the soft tissues surrounding the left thyroid lobe. In these cases, no cyst wall can be found. The 3 cases reported here allow us to ascertain that a pharyngeal infection is the trigger for the neck abscess. Furthermore, a mucosal opening can be the only found anomaly. After recovery from the infectious process, these anomalies have to be treated by a mucosal suture of the pyriform sinus. The recurrent laryngeal nerve should be first discovered and the removal of a small piece of cartilage can be required. If these diagnostic and therapeutic procedures are used at the first infectious episode, they may prevent the occurrence of repeated thyroid "abscesses" in children.