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Clinical Note
September 1998

Endoscopic Cauterization for Treatment of Fourth Branchial Cleft Sinuses

Author Affiliations

From the Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas (Drs Jordan, Manning, McClay, and Biavati); and Pediatric Ear, Nose & Throat Associates, Knoxville, Tenn (Dr Graves). Dr Manning is now with the Department of Otolaryngology, University of Washington, Seattle.

Arch Otolaryngol Head Neck Surg. 1998;124(9):1021-1024. doi:10.1001/archotol.124.9.1021

Fourth branchial cleft sinuses are rare, and the nature of their origin is controversial. Clinical presentation is varied because they may present as asymptomatic neck masses, recurrent neck abscesses, or suppurative thyroiditis. We describe herein 7 children who presented with abscesses on the left side of their necks, 3 of whom had abscesses that involved the thyroid gland. Direct laryngoscopy revealed that all 7 children had a sinus tract opening into the apex of the piriform sinus. Endoscopic obliteration of this tract was achieved using an insulated electrocautery probe either when the abscess was initially incised and drained or 4 to 6 weeks later. All 7 children recovered uneventfully. Four of the 7 children were followed up for more than 18 months without recurrence.

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