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Complete congenital third branchial fistula with left-sided, recurrent, suppurative thyroiditis

  • J Madana (a1), D Yolmo (a1), S Gopalakrishnan (a1) and S K Saxena (a1)

Abstract

Objective:

We report an extremely rare case of a complete congenital third branchial arch fistula in a nine-year-old boy.

Method:

A case report and a review of the English literature concerning third branchial arch fistula of congenital origin are presented.

Results:

A nine-year-old boy presented with a history of a small opening in the middle third of the anterior neck since birth, with recurrent surrounding swelling. There was no history of surgical drainage or spontaneous rupture. Computed tomography with contrast injection into the external cervical opening revealed a patent tract from the neck skin to the base of the pyriform sinus. Complete excision of the tract up to the pyriform sinus with left hemithyroidectomy was performed. Follow up at 22 months showed no recurrence.

Conclusion:

To our knowledge, this case represents a very rare occurrence of the congenital variety of complete third branchial arch fistula at an unusual site. This case indicates that third branchial arch fistula can be complete, and may present in the anterior neck, an unusual site. In such cases, computed tomography fistulography and injection of dye into the pyriform sinus enables intra-operative delineation of the tract.

Copyright

Corresponding author

Address for correspondence: Dr J Madana, Senior Resident, Department of Otorhinolaryngology, JIPMER, Pondicherry 605006, India. E-mail: maddyy@gmail.com

References

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1Chaudhary, N, Gupta, A, Motwani, G, Kumar, S. Fistula of the fourth branchial pouch. Am J Otolaryngol 2003;24:250–2
2Jaka, RC, Singh, G. Complete congenital third branchial fistula on right side. Otolaryngol Head Neck Surg 2007;137:518–19
3James, A, Stewart, C, Warrick, P, Tzifa, C, Forte, V. Branchial sinus of the piriform fossa: reappraisal of third and fourth branchial anomalies. Laryngoscope 2007;117:1920–4
4Nicoucar, K, Giger, R, Pope, HG Jr, Jaecklin, T, Dulguerov, P. Management of congenital fourth branchial arch anomalies: a review and analysis of published cases. J Pediatr Surg 2009;44:1432–9
5Mali, VP, Prabhakaran, K. Recurrent acute thyroid swellings because of pyriform sinus fistula. J Pediatr Surg 2008;43:e2730
6Kubota, M, Suita, S, Kamimura, T, Zaizen, Y. Surgical strategy for the treatment of pyriform sinus fistula. J Pediatr Surg 1997;32:34–7
7Liberman, M, Kay, S, Emil, S, Flageole, H, Nguyen, LT, Tewfik, TL et al. Ten years of experience with third and fourth branchial remnants. J Pediatr Surg 2002;37:685–90
8Garrel, R, Jouzdani, E, Gardiner, Q, Makeieff, M, Mondain, M, Hagen, P et al. Fourth branchial pouch sinus: from diagnosis to treatment. Otolaryngol Head Neck Surg 2006;134:157–63

Keywords

Complete congenital third branchial fistula with left-sided, recurrent, suppurative thyroiditis

  • J Madana (a1), D Yolmo (a1), S Gopalakrishnan (a1) and S K Saxena (a1)

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