Anomalies in the fourth pharyngeal apparatus as cause of deep recidivant neck infections

Abstract

Most of the deep neck infections originate from a focus in the upper aerodigestive mucous or from a dental focus, congenital anomalies only correspond to a 2% of the causes. Clinical presentation is quite similar independently from the etiology and in many occasions clinic is not sufficient to reach a correct etiological diagnosis. The presence of a repeated infection of the deep space in the neck (IEPC) is highly suggestive of a congenital anomaly of which approximately 58% derive from the pharyngeal apparatus. From these, those coming from the IV pharyngeal apparatus are extremely rare, being more frequent in childhood, in the left side of the neck and in female patients. These congenital IEPC also show good response to antibiotic therapy and/or drainage that is why it masks it as an etiological factor. It is difficult to make a diagnosis of pharyngeal apparatus IV development abnormality. They are infrequent (1-2% of the congenital abnormalities) and are clinically presented as recurrent abscesses of the deep space of the neck, to the left hand side, generally during childhood, accompanied or not by an acute left side suppurating thyroiditis associated to a persisting finding of the cavity in the apex of the pyriform cavity. 3 patients are reported with left side cervical abscess secondary to an anomaly in the development of the pharyngeal apparatus IV.