Otolaryngology Case Reports (Nov 2020)
A case of fourth branchial cleft anomaly treated with open surgery
Abstract
Branchial cleft anomalies represent approximately 17% of all pediatric neck masses (Tong et al., 2016) [1] in which fourth branchial arch anomalies represent less than 1%.We report the case of a 3 years old male, presenting with a left neck inflammatory mass of 4cm associated with fever and anorexia. Ultrasound reveals an abscess of the left thyroid lobe. Contrast enhanced CT scan revealed a left thyroid hypodense area, with disappearance of the cleavage area with the SCM muscle. In late time, after Valsalva's maneuver, the appearance of a left intra-thyroid air bubble was noticed. This surgery consisted on a prior laryngoscopy followed by a cervicotomy. The orifice of the sinus was found in the left piriform fossa. The cervicotomy revealed a sinus of 5cm, located between the common carotid artery and the internal jugular vein, descending to the thoracic orifice. It's resection was done and 3.0 resorbable sutures were done at each sinus extremity. The interposition of a fragment of sternocleidomastoid muscle was done to ensure the total closure of the sinus. No suppurative event or neck infections were noticed 9 months after surgery.Open surgical treatment gives good results and represent a good alternative in a poorly equipped environment.
