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.

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.