• Korean Journal of Bronchoesophagology
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• v.6 no.1
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• pp.96-101
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• 2000

It is commonly believed that the branchial anomalies are remnants of the branchial apparatus. Third and fourth branchial pouch anomaly is an extremely rare disease involving the branchial apparatus. Virtually mostly reported cases have been on the left side and has been identified in recurrent suppurative thyroiditis, retropharyngeal abscess and repeated episodes of cellulitis, neck swelling, lateral neck fistula. Recently the authors have experienced a case of left piriform sinus fistula accompanied with left suppurative thyroiditis, presumably of fourth branchial origin in a 50-years old male patients, which was successfully treated with coagulation, and so report this case with summary of branchial anomaly by the some review of the literatures.

• Korean Journal of Head & Neck Oncology
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• v.8 no.1
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• pp.6-13
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• 1992

Branchial apparatus anomaly is rarely encountered congenital neck disease, it presents a palpable non-tender mass or fistulous opening existed at any site from external auditory canal or mandible angle to lower part of neck We have reviewed the records of 50 patients operated upon for branchial cleft anomaly, at Department of Surgery, Inje University Hospital, between 1981 and 1990, and the following results were obtained. I) In the classificiation of branchial cleft anomaly, first branchial fistula was 1 case, second branchial cyst 32 cases, second branchial sinus 11 cases, second branchial fistula 5 cases and third branchial fistula 1 case. 2) There were 20 men and 30 women in this series and male to female ratio was 2:3. 3) The age at first clinical presentation was 1st decade 15 cases, 2nd decade 10 cases, 3rd decade 17 cases, 4th decade 5 cases and 5th decade 3 cases. The peak age incidence was 3rd decade in overall, but the cyst was most common in 2nd decade, and majority of sinus or fistula was seen below 10 years old age. 4) The prevalent side of this anomaly was right side in 19 cases, left side in 29 cases and bilateral 2 cases, and so left side was more common than right. 5) The clinical presentation was characterized by the lesion along anterior border of sternocleido muscle, non-tender palpable mass were 28 cases, drainage sinus 18 cases, recurrent abscess and drainage 5 cases and intermittent ear discharge 1 case. 6) The mean size of cyst was about 4cm that containing turbid white-yellowish fluid but discharge from sinus or fistula was clear mucoid. 7) The culture of cyst fluid was no bacteria, but 2 cases showed staphyloccoci suggesting secondary infection. 8) The surgical procedure were complete excision of cyst 32 cases, sinus excision 11 cases, fistula excision 6 cases and I&D 1 case. And the recurrent 1 case was that fistula tract could not be identified due to severe scar from previous several operations.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1993.05a
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• pp.109-109
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• 1993

Fourth branchial pouch anomaly is an extremely rare condition involving the pharyngeal apparatus with only about 30 cases having been reported in the last 20 years. It almost invariably occurs on the left side and typically presents with repeated episodes of neck swelling, recurrent thyroiditis, or repeated bouts of retropharyngeal abscess. This is a presentation of 2 patient with pyriform sinus fistula, presumably of fourth branchial origin, which, were successfully closed with 10ole trichloroacetic acid chemical cautery. Details of the cases along with the summary of embryology and fourth branchial anomaly are given.

• Korean Journal of Head & Neck Oncology
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• v.25 no.1
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• pp.12-17
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• 2009

Background and Objectives : Branchial anomaly is a common neck pathology seen by otolaryngologist. Although there is still controversy regarding the origin, almost all surgeon agree that branchial anomalies result from incomplete involution of the branchial apparatus. Depending on its anatomic location, branchial anomalies can be classified into first, second, third and fourth anomaly. The purpose of this study is to evaluate the incidence of different categories of branchial anomalies and to determine proper method of diagnosis and treatment. Subjects and Method : A retrospective chart review was conducted for 72 patients with branchial anomalies operated on at the Korea University Anam Hospital from 1996 to 2007. The patient's sex, age, presenting symptoms, classification, site of lesion, diagnostic studies, surgical therapy and post-operative surgical complication were reviewed. Results : Patients were commonly seen in the 3rd decades. Eleven patients(15.3%) were first branchial anomalies, 52(72.2%) were second, 1(1.4%) was third, and 8(11.1%) were fourth. Of the types of anomalies, cyst were most commonly seen. In cases of 3rd and 4th branchial anomalies, barium contrast study can delineate the course of sinus or fistula. All cases was operated on for branchial anomalies, there were no major post-operative complication. Conclusion : Cervical mass and recurrent cervical infection or abscess are suspect for branchial anomalies. Especially, clinical history of dysphagia, and recurrent painful swelling in the thyroid region in young patients should raise the suspicion of 3rd and 4th branchial anomalies. Careful history, clinical examination and radiographic study were essential parts in diagnosis of branchial anomalies. Although surgical management of branchial anomalies depend on its type, nature and extent, complete excision is the major surgical procedure.

• Korean Journal of Head & Neck Oncology
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• v.11 no.1
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• pp.56-62
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• 1995

Branchial cleft cyst is rarely encountered congenital neck disease. It is commonly believed that the branchial anomaly is persistance of remnant of the embryologic branchial apparatus. Among the patients visited Kyung Hee Medical Center with neck mass and inflammatory sign from January, 1980 to Aprial, 1994, we reviewed 26 cases of branchial cleft cysts confirmed by histopathologic findings with retrospective study on clinical aspects. The results are as follows: 1) There was no sex difference(14 male and 12 female), and most common between 2nd and 4th decade(21 cases, 80%). 2) Palpable mass was most common complaint(21 cases). In physical exam, the mass was non-tender, mobile and soft in most cases(over 80%). 3) The most common lesion site was anterior triangle in 15 cases. Along the SCM level, 21 cases were in upper 1/3, 2 cases in middle 1/3 and 3 cases in lower 1/3. 4) According to Bailey's classification, type II were 20 cases(76.9%), type I 5 cases(19.2%) and type III 1 case. 5) Among 28 cases, fistulous tract was found in 6 cases: one was complete type and 5 were incomplete type. 6) Among 26 cases before operation, 10 cases were diagnosed as branchial cleft cyst, 6 cases tuberculosis, 3 cases parotid tumor and 2 cases thyroglossal duct cyst. 7) Type of lining epithelium in histopathologic finding was stratified squamous epithelium in 22 cases(84.6%), mixed type in 4 cases(15.4%).

• Korean Journal of Head & Neck Oncology
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• v.17 no.2
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• pp.234-237
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• 2001

Pyriform sinus fistula is a rare anomaly arising from 3rd or 4th branchial apparatus and has been recognized as one cause of acute suppurative thyroiditis or acute deep neck infection. Pyriform sinus fistula must be considered when a clinician is encountered recurrent left lower neck abscess and a history of repeated incision and drainage. The confirmation of the diagnosis is made when the fistula tract is identified on a barium swallow study and when the internal orifice of the fistula is found at the apex of pyriform sinus on laryngoscopic examination. A complete excision of the fistula tract has been proposed as a treatment of choice. However, in some cases it is very difficult to resect the tract completely because of severe inflammation and repeated drainage procedure. We present three cases of pyriform sinus fistula which are successfully treated by laryngomicroscopic chemocauterization using synthetic fibrin and $AgNO_3$.

• Archives of Plastic Surgery
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• v.35 no.6
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• pp.703-708
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• 2008

Purpose: Microtia is a congenital anomaly resulting from abnormal development of the branchial apparatus. Although significant modification and improvement of operative procedures for the reconstruction of the auricle with a natural appearance have been reported, postoperative complications, such as infection, flap necrosis and deformity, still remain serious problems in patients. Many studies with long-term results have focused mainly on operative procedures for an acceptable auricular shape without consideration of possible complications. Methods: We conducted a retrospective study on postoperative complications at the recipient sites of 183 patients who underwent auricular reconstruction with autologous rib cartilage grafts from November 1987 to January 2007 at the Division of Pediatric Plastic Surgery, Seoul National University Children's Hospital. Patients were analyzed in terms of the kinds and incidences of complications, and their treatment options. Results: Postoperative complications included wound dehiscence, flap necrosis, infection, hypertrophic scar, auricular deformity and absorption of rib cartilage grafts. The complications occurred in 47 patients with a complication rate of 25.7%. Fourteen patients were successfully managed with conservative treatment. However, surgical treatment was required in 51 reoperations(33 patients) of total 329 operations. Conclusion: Postoperative complications at the recipient sites of autologous rib cartilage grafts occurred with relatively high incidences and required long-term treatments and multiple surgeries. The results of this study may provide information on the causes and proper management of postoperative complications as well as safe procedures for the reconstruction of the auricle.