Multidisciplinary management of third and fourth branchial remnants at a pediatric hospital

Background: Third and fourth branchial remnants account for less than 4% of all branchial anomalies. Despite the availability of diverse imaging techniques, underdiagnosis is frequent. The objective of this study is to describe the experience of the multidisciplinary treatment of patients with third and fourth branchial remnants in a tertiary care pediatric hospital in Colombia. This is a retrospective descriptive observational case series study. The objective was to describe diagnostic and therapeutic variables of children with third and fourth branchial remnants treated at the Fundación HOMI from January 2018 to January 2023.Results: Eight patients met the inclusion criteria. The female to male ratio was 3:1. The mean age at diagnosis was 75.1 months (22-177, SD 57.3). All lesions were located on the left neck. All patients presented with an abscess at the time of diagnosis. The initial treatment in 38% of patients was based on a mixed approach involving endoscopic cauterization of the fistula and surgical excision of the tract under ultrasound guidance. An average of 1.6 cauterizations were performed in each case (0-3, SD 1). The mean duration of follow-up was 108.6 days (0-556, SD 192.2), and at the end of this period, 75% of the patients were asymptomatic.Conclusions: The diagnosis of pyriform sinus fistulas warrants a high level of suspicion. A combined approach of endoscopic strategies and ultrasound-guided surgery increases the likelihood of success and may reduce morbidity