Abstract
BackgroundA pyriform sinus fistula (PSF) is a rare branchial anomaly that causes recurrent cervical infections. Open neck surgery has widely been accepted as a definitive treatment for PSFs, and endoscopic surgery has been reported in recent years. However, both approaches are not satisfactory because of high recurrence rates and postoperative complications. Microlaryngoscopic surgery (MLS) is a transoral surgical technique involving the use of an operating microscope. In this report, we present a new procedure involving MLS for resection and closure of a PSF without a skin incision.Case presentationTechnique: MLS was performed under general anesthesia with endotracheal intubation. The patient was placed in the supine position, and a direct laryngoscope was inserted to expose the pyriform sinus, which was then magnified using an operating microscope. The mucosal layer was carefully resected using scissors and cupped forceps with sharp edges. The fistula was securely sutured using absorbable suture material. Case 1: A 9-year-old boy with recurrent neck abscesses since 8 years of age presented to our hospital after receiving antibiotics and undergoing drainage in other hospitals. After admission to our hospital, barium esophagography and oral contrast coronal computed tomography showed a PSF on the left side, and open neck surgery was performed to resect the fistula. He was eventually discharged from the hospital without any problem. However, a PSF recurred 2 weeks later. As reoperation with the cervical approach was considered difficult owing to severe adhesions, we adopted MLS as a definitive operation. The postoperative course was uneventful. No recurrence was observed during an 18-month follow-up. Case 2: A 10-year-old girl presented to our hospital with recurrent left-sided neck swelling since 6 years of age. After inflammation control, a PSF was identified on the left side on barium esophagography and computed tomography. MLS was performed safely, and the postoperative course was uneventful. No recurrence was observed during a 10-month follow-up.ConclusionsMLS allows excellent visualization and effective closure for PSFs, and this approach is suitable for recurrence after open neck surgery. Therefore, MLS might become a first-line treatment for PSFs in children.
Highlights
A pyriform sinus fistula (PSF) is a rare branchial anomaly that causes recurrent cervical infections
Microlaryngoscopic surgery (MLS) allows excellent visualization and effective closure for PSFs, and this approach is suitable for recurrence after open neck surgery
A pyriform sinus fistula (PSF) is a rare congenital anomaly caused by incomplete obliteration of the third or fourth pharyngeal bursa during the seventh week of gestation [1, 2]
Summary
A pyriform sinus fistula (PSF) is a rare congenital anomaly caused by incomplete obliteration of the third or fourth pharyngeal bursa during the seventh week of gestation [1, 2]. Case 1 A 9-year-old boy presented to our hospital with a history of recurrent neck abscesses since 8 years of age. He had received antibiotics and had undergone drainage of the abscesses in other hospitals. Oral contrast coronal computed tomography (CT) showed an air- and barium-containing fistula (Fig. 2b). He underwent open neck surgery for definitive treatment of the PSF. Barium esophagography was performed, and it showed a PSF on the left side. No recurrence was observed during a 10-month follow-up
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