The fourth branchial cleft deformity on the left anterior chest wall: a case report and literature review / 口腔疾病防治

Objective @#To explore the main points of clinical treatment of fourth branchial cleft deformity in special positions and to provide a reference for clinical practice. @*Methods@#The clinical data of one case of a fourth branchial cleft deformity that occurred in the left anterior chest wall with a fistula below the clavicle are summarized and combined with a literature review.@*Results@# The patient complained of repeated swelling and pain under the left anterior chest wall for 2 months. A 10 mm×10 mm fistula with yellow clear liquid exudate from the fistula was observed on the left side below the clavicle. A 20 mm×20 mm×10 mm swelling was immediately adjacent at the superficial cervicothoracic junction of the upper sternoclavicular joint, with no fluctuation and poor activity; this swelling produced slight pain upon pressing. Imaging examinations pointed to cystic lesions. The primary diagnosis was a fourth branchial deformity. A small amount of methylene blue was injected into the patient's subclavian fistula, and a supraclavicular T-shaped incision was made where the cyst contacted the fistula. By turning the flap, all the methylene blue-stained areas and adjacent submucosal tissues were exposed. During the operation, a mass was found on the sternum. The platysma was found deep in the notch, which was incised before excising the surrounding area. The pathological result is the fourth branchial cleft deformity. After 1 week and 3 months of follow-up, the patients had no discomfort and no recurrence. A review of the relevant literature shows that the fourth branchial cleft deformity is a congenital developmental abnormality that occurs in 1% of all branchial cleft deformity. It often presents as a fistula, cyst, or sinus tract and is anatomically located at the neck root and supravicular region. The fistula is close to the medial lower boundary of the sternocleidomastoid muscle. The diagnosis is often made based on its anatomical location, imaging examinations and, ultimately, pathology. The differential diagnoses include other cervical swellings, such as hemangioma and a thyroglossal duct cyst. Surgical resection is a commonly used treatment method. In recent years, endoscopic positioning and internal fistula burning have had good curative effects for recurrent fourth branchial cleft deformity, with a small chance of recurrence or cancer.@* Conclusion @#Given its unique position, clinicians should make full use of imaging methods to determine the size, anatomical location and course of the lesion when treating the fourth branchial cleft deformity to ensure the complete and safe surgical resection of the lesion and prevent recurrence.

The Combination Therapy of Chemocauterization and Electrocauterization on Fourth Branchial Cleft Cyst

BACKGROUND AND OBJECTIVES: Fourth branchial cleft cyst is a rare congenital anomaly which cause a recurrent cervical abscess. Complete excision of fourth branchial cleft cyst is difficult because of a complicated fistula tract. In addition to attempting chemocauterization with trichloroacetic acid (TCA) to avoid surgical complications, authors performed an electrocauterization to close internal opening of pyriform sinus. MATERIALS AND METHODS: We reviewed ten patients of fourth branchial cleft cyst underwent TCA chemocauterization and electrocauterization simultaneously. Clinical characteristics including patient informations, medical records, treatment results were analyzed retrospectively. RESULTS: Interval time until diagnosed with fourth branchial cleft cyst was variable from several days to decades. Five patients had a history of incision and drainage. Mean follow up period was 36.1 months and all patients were treated with no recurrence. CONCLUSION: TCA chemocauterization with electrocauterization can be a effective choice to reduce recurrence rate and ensure safety of patients of fourth branchial cleft cyst.

A Case of Actinomycotic Thyroiditis in a Child with Fourth Branchial Cleft Fistula / 소아과

Fistulas of the fourth branchial pouch have an external opening in the neck and the inner opening at the apex of the pyriform fossa. The tract passes from the left lobe of the thyroid, resulting in acute suppurative thyroiditis in most cases. Actinomycosis is an indolent, slowly progressive infection caused by anaerobic or microaerophilic gram-positive bacteria, primarily of the genus Actinomyces. These bacteria are filamentous with branching and may colonize in the oral cavity. Actinomycosis is a chronic disease characterized by abscess formation, tissue fibrosis, and draining sinuses. We experienced a case of 6-year-old boy who had presented with a left neck mass. Neck sono showed an approximately 3 cm-sized low echoic mass in the left thyroid gland. Thyroid scan was compatible with thyroid hypofunction. Gomori-methenamine silver stain after fine needle aspiration showed colonies of bacteria, are composed of long, thin, filamentous bacteria. Barium esophagogram showed a linear barium-filled track at the left pyriform sinus. Neck excisional biopsy was consistent with the remnant of a fourth branchial cleft fistula. We report a case of actinomycotic thyroiditis in a child with fourth branchial cleft fistula, with a brief review of related literature.

Two Cases of Presumed Fourth Branchial Cleft Cyst in Neonate / 대한이비인후과학회지

A cystic mass of the neck causing neonatal respiratory distress is usually cystic hygroma. A branchial cleft cyst, however, also can cause respiratory distress on rare cases. The fourth branchial cleft cyst is very rare entity and, until now, only 35 cases have been reported worldwide. There have been some controversial attempts to prove its anatomical route through embryological background. Some reports, however, even suggested that it might be impossible to prove its entity anatomically. Recently, reports are coming out on the diagnostic approaches using not only anatomical pathway but also pathological impression. Authors experienced in neonates two cases of lateral cystic neck mass which were pathologically presumed to be fourth branchial cleft cyst. We are reporting these two cases with their diagnostic basis and the related literature.