Revisiting Imaging Features and the Embryologic Basis of Third and Fourth Branchial Anomalies
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Abstract:
There is wide discrepancy between common clinical and radiologic presentations of branchial sinuses arising from the pyriform fossa and the theoretic course of third and fourth branchial arch anomalies. The purpose of this study was to revisit the clinical presentations and imaging features of such anomalies in children.A retrospective review of institutional and diagnostic imaging data bases from 1998 to 2008 for reported cases of third and fourth branchial cleft anomalies was conducted. Clinical presentation, pharyngoscopy results, and imaging features in all the patients were evaluated. Surgical and histopathology correlation in patients who underwent excision of the tract was also obtained.Twenty reported cases described as third or fourth branchial apparatus anomalies were identified. There were 12 females and 8 males with a mean age of 84.6 months. The most common presentation was an inflammatory neck mass (18/20, 90%) almost always involving the thyroid gland. Most lesions were on the left side (16/20, 80%). Pharyngoscopy showed a sinus opening at the piriform fossa in 18/20 (90%) cases. None of the cases followed the classic theoretic pathway of third and fourth arch remnants. Histopathology showed tracts lined with pseudostratified squamous epithelium or ciliated columnar epithelium often associated with inflammatory changes in 17 surgically resected cases.Branchial sinuses arising from the pyriform fossa often present with an inflammatory neck mass involving the thyroid lobe, most often on the left side. Imaging and surgical findings suggest that they arise from the embryonal thymopharyngeal duct of the third branchial pouch, because they do not follow the hypothetic course of third or fourth arch fistulas.Keywords:
Histopathology
Branchial arch
Presentation (obstetrics)
Fossa
Temporal fossa
Sinus (botany)
Neck mass
Fossa
Temporal fossa
Infratemporal fossa
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The fourth branchial pouch sinus is a rare anomaly of the branchial arch apparatus. The 31st reported case of a fourth branchial sinus is presented. A thorough understanding of the developmental anatomy of the branchial region is necessary for the detection and treatment of this entity. The diagnosis can be made with a high index of suspicion in patients with recurrent left neck infections by demonstration of a pyriform sinus tract on pharyngoesophagram. Treatment consists of complete surgical excision following exposure of the entire course of the sinus tract including its insertion into the apex of the pyriform sinus.
Sinus (botany)
Pyriform Sinus
Pouch
Branchial arch
Pharyngeal pouch
Apex (geometry)
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The growth of the glenoid fossa is assumed to follow that of the cranial base. It has been observed recently that distal displacement in association with an obtuse cranial base angle is reduced on remodeling of the fossa anteriorly as a consequence of a more anterior position of the condyle in the fossa. The aim of this investigation was to simulate the increased distal displacement experimentally by causing a premature artificial cranial synostosis. Ten 10-day-old rabbits underwent gluing of the interparietal and temporoparietal sutures. These and ten controls were killed at 50 days for examination, and the articular surface of the right glenoid fossa was marked with a soft metal wire. The skulls were roentgenographed in standardized lateral projection. The articular surface was significantly shallower in relation to the skull base in the experimental group, and the glenoid fossa was located more superiorly and posteriorly. The most likely reason for the more horizontal direction of the articular surface is the more anterior location of the condyle, exerting increased pressure on the eminence. This becomes important, as it has recently been shown that in rabbits this shallowing of the fossa is associated with increased forward growth of the mandible.
Fossa
Temporal fossa
Middle cranial fossa
Mandible (arthropod mouthpart)
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The purpose of this work was to compare glenoid fossa dimensions and craniofacial morphology on the basis of standard lateral roentgenograms. To overcome the difficulties encountered in making exact measurements on living subjects, 59 dry skulls were used. Eight angular measurements were taken to describe the form of the skull base, mandible, and articulating surface of the glenoid fossa, four linear measurements to describe the position of the fossa, and one to describe the size of the whole skull. A close relationship was observed between the morphology of the articulating surface of the glenoid fossa and the mandibular morphology. The skull base angulation was associated with the position of glenoid fossa in two ways. Basically, the position of the fossa is related to skull base characteristics, but the location of the articular eminence in relation to the clival plane suggests that the mandibular condyle may cause a remodeling of the eminence anteriorly when the glenoid fossa otherwise is translocated posteriorly in association with the flat skull base.
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Middle cranial fossa
Temporal fossa
Mandible (arthropod mouthpart)
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Fossa
Temporal fossa
Mandible (arthropod mouthpart)
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In order to investigate the role of the glenoid fossa in the morphogenesis of the mandible, the articulating surface of the left glenoid fossa was rotated more vertically with the aid of premature synostosis of frontoparietal and frontotemporal sutures at the age of five days in the rat. The glenoid fossa was more anteriorly located relative to the incisors and molars, and the articulating surface of the fossa was more steeply inclined in relation to the palatal plane or the cranial base. The length of the mandible was slightly decreased and the height was increased at 35, 50 and 100 days of age. The condylar process of the experimental mandibular halves was more vertically oriented at the ages of 35, 50 and 100 days. The results of this investigation indicate that the shape of the glenoid fossa has an effect on the morphology of the mandible
Fossa
Mandible (arthropod mouthpart)
Temporal fossa
Middle cranial fossa
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Three anatomical features(canine fossa,the marginal process of the zygomatic bone and the amount of bulging between the orbit and the pyriform orifice)of 11 ancient Chinese human groups were analyzed using Chi-squared tests in order to identify between-group variation.The results show that for the different ethnic groups,the frequency in the occurrence of the canine fossa in males could be reflected on the differentia of variation.The marginal process of the zygomatic bone could be reflected on the differentia of ethnic groups in some extent.Since the Han Dynasty in a comparative study between European males of Xinjiang and Mongoloid males of northern China,there is a distinct statistical difference in terms of the amount of bulging between the orbit and the pyriform orifice.And yet,the author found a correlation between the obvious appearance of the canine fossa and the amount of bulging between the orbit and pyriform orifice.To explain this correlation and its cause,the author puts forward two hypotheses:1)when nasal morphology changes,it brings about facial bulging and then the canine fossa develops;2)with degeneration of the maxilla and canine,a strong canine fossa develops and along with it,facial bulging.
Fossa
Temporal fossa
Orbit (dynamics)
Mongoloid
Zygomatic arch
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Temporal fossa
Mandible (arthropod mouthpart)
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Temporal fossa
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