Objectives

Third and fourth branchial pouch sinuses can be rare causes of respiratory distress in neonates. An overview of this distinct clinical entity is missing in literature. To aid clinicians in recognizing and adequately treating this unique entity, we conducted a systematic review to discuss patient characteristics, diagnostic considerations and treatment strategy.

Methods

MEDLINE and EMBASE were searched from inception to December 29th^, 2020. Original studies concerning patients with respiratory symptoms as a result of a third or fourth branchial pouch sinus, as confirmed with rigid endoscopy, videofluoroscopy or during surgery.

Results

Thirty-nine studies describing 56 patients (66% male, aged 0–30 days) were analyzed. Symptoms included cervical mass (76.8%), stridor (55.4%), dyspnea (35.7%) and cyanosis (17.9%) due to a third (39.3%) or fourth (60.7%) branchial pouch sinus. Intubation was performed before treatment in 31.3%. The piriform sinus opening was identified with rigid endoscopy in 81.1%. Surgery was the treatment of choice in the majority of patients (85.7%), with a success rate of 100% and a complication rate of 10.7%. Endoscopic cauterization was successful in 40% and endoscopic cauterization followed by sclerotherapy was successful 100%, with no complications.

Conclusion

Third or fourth branchial pouch sinuses can lead to respiratory distress in neonates. It is important to recognize this distinct clinical picture for adequate diagnosis and treatment. Rigid endoscopy is indicated to demonstrate an opening in the piriform sinus and provides the opportunity to directly perform treatment with endoscopic cauterization. If this is insufficient to relief respiratory symptoms due to a persistent cyst, sclerotherapy or surgical excision should be considered.

中文翻译：

---

第三或第四鳃袋窦引起的新生儿呼吸窘迫：系统评价

目标

第三和第四鳃袋窦可能是新生儿呼吸窘迫的罕见原因。文献中缺少对这种独特临床实体的概述。为了帮助临床医生识别并充分治疗这个独特的实体，我们进行了系统回顾以讨论患者特征、诊断考虑和治疗策略。

方法

MEDLINE和EMBASE从开始搜查，以12月29日^， 2020年关于患者的呼吸道症状为第三或第四鳃囊窦的结果，证实了硬性内窥镜，电视透视检查或手术过程中原始研究。

结果

对描述 56 名患者（66% 男性，年龄 0-30 天）的 39 项研究进行了分析。症状包括颈部肿块 (76.8%)、喘鸣 (55.4%)、呼吸困难 (35.7%) 和因第三 (39.3%) 或第四 (60.7%) 鳃袋窦引起的紫绀 (17.9%)。31.3% 的患者在治疗前进行了插管。81.1% 的患者通过硬性内窥镜检查发现了梨状窦开口。大多数患者（85.7%）选择手术治疗，成功率为100%，并发症发生率为10.7%。内镜烧灼成功率为 40%，内窥镜烧灼后硬化治疗成功率为 100%，没有并发症。

结论

第三或第四鳃袋窦可导致新生儿呼吸窘迫。重要的是要认识到这种独特的临床表现，以便进行充分的诊断和治疗。硬性内窥镜用于证明梨状窦的开口，并提供直接进行内窥镜烧灼治疗的机会。如果这不足以缓解持续性囊肿引起的呼吸道症状，应考虑硬化疗法或手术切除。