PDF(Pubmed)
Abstract：
Fourth branchial anomalies are extremely rare and are often misdiagnosed. A recurrent history of anterior neck discharges or infections since childhood should raise a high clinical suspicion of branchial fistula and necessitate a thorough clinical, endoscopic, and radiological evaluation. We report a rare case of right-sided fourth branchial fistula in a middle-aged lady who was referred to us for recurrent right neck infections since childhood and had received multiple courses of antibiotics and drainage of abscesses. Despite previous negative barium swallow and fistulogram results, the diagnosis of the branchial fistula was made clinically with the spillage of methylene blue dye into the apex of the right pyriform sinus from flexible nasopharyngolaryngoscopy in the clinic after the injection of dye through the fistula opening at the neck. Finally, another barium swallow study and computed tomography scan were conducted, revealing the fistula tract. Complete surgical excision of the fistula tract was then performed with no evidence of recurrence after six months of follow-up.
摘要：
第四分支异常极为罕见，经常被误诊。自儿童以来反复出现的前颈放电或感染的病史应引起高度的临床怀疑，并需要进行彻底的临床检查，内窥镜,和放射学评估。我们报告了一例罕见的中年女士右侧第四分支瘘病例，她从小就因复发性右颈感染而被转诊给我们，并接受了多个疗程的抗生素和脓肿引流。尽管之前的钡吞咽和造影图结果为阴性，在临床上，通过颈部瘘管口注射染料后，亚甲蓝染料从柔性鼻咽喉镜溢出到右梨状窦的顶端，诊断为分支瘘。最后,进行了另一项钡吞咽研究和计算机断层扫描，露出瘘管道。然后进行了完整的瘘管手术切除，随访六个月后没有复发的迹象。
