Differences in the characteristics and management of pyriform sinus fistula between neonates and young children

Abstract

Pyriform sinus fistula (PSF), which originates from the third or fourth branchial pouch remnant, is relatively rare. In young children and adults, it is characterized by lateral neck infections and suppurative thyroiditis, while neonatal PSF presents as a large cervical cystic mass and causes respiratory distress. We hypothesized that the characteristics and management of PSF may differ between neonates and young children. Hospital case records of the neonatal group and the young children's group presenting between January 2002 and December 2010 were retrospectively reviewed. We analyzed differences in the presenting symptoms, diagnostic images, and operative findings between the groups. Twelve patients (5 males and 7 females) of PSF were identified. In neonatal PSF, the orifice of the pyriform sinus was commonly wide, with a large cyst, readily enabling the insertion of a guide wire. In young children, PSF caused cervical pain and suppurative thyroiditis, and the opening of the fistula was relatively small. Supportive cannulation was not easily performed. There are distinctive etiological differences between the neonatal and young children's groups. In the case of unsuccessful supportive cannulation, direct visualization of the pyriform fossa is a useful procedure for complete resection of PSF, with incision of the inferior pharyngeal constrictor muscle.