Treatment Of Pyriform Sinus Fistula Research Articles

Closure of the Entire Fistula With Highly Effective Chemocauterization Using the Distal Hood Endoscope: A Novel Procedure for the Treatment of Pyriform Sinus Fistula.

Pyriform sinus fistula (PSF) causes a recurrent abscess in the neck. Endoscopic chemocauterization with trichloroacetic acid (TCA) for PSF is a simple, reproducible, and reliable procedure for treating PSF; however, there is concern about complications caused by TCA overflowing into the larynx. To prevent these complications, we devised a highly effective chemocauterization using a distal hooded endoscope (HuDHE). Our aim is to determine the efficacy and safety of HuDHE in children with PSF. The main features of HuDHE are as follows(1) an endoscope with a translucent silicon hood at the tip was made; (2) TCA was endoscopically injected into the PSF; and (3) the color change of the mucosa into PSF was endoscopically evaluated. Data on children receiving HuDHE for PSF in the past seven years were collected from medical records. Data were obtained for eight children receiving HuDHE. The success rate of treatment for PSF after the first TCA chemocauterization was 87.5% (7/8) and the cumulative success rate after the second treatment was 100% (8/8). None of the children had recurrent PSF or serious complications such as vocal cord paralysis after HuDHE. HuDHE appears to be a less invasive, safe, and effective treatment for PSF.

Endoscopic Suture With Chemocauterization: An Effective Treatment of Congenital Pyriform Sinus Fistula.

Endoscopic cauterization is an effective method for treating pyriform sinus fistula (PSF). However, these approaches sometimes result in a higher failure rate. We present an effective technique utilizing suture combined with chemocauterization as first-line treatment in patients with PSF and evaluate the safety and efficacy of its use in 126 patients. Retrospective study. Tertiary referral center. Retrospective case review of patients treated between March 2012 and June 2021 at our institution with descriptive statistical analysis. A total of 126 patients with PSF were included in this study with a mean age of 14.7 years. There was no sex predilection. The majority of patients presented with a left-sided neck lesion (89.7%). Ten patients presented following prior attempts at the surgery of the PSF at another institution; 8 via open surgery and 2 following endoscopic CO2 laser cauterization; other patients only had a history of repeat incision and drainageor antibiotic treatment. The success rate of obliteration of the internal opening was 96.83% after a single treatment without complications. Following reoperation, a successful outcome was achieved in the remaining 4 patients. Length of stay ranged from 10 to 14 days. No recurrences occurred within 12 to 120 months followed-up. Endoscopic suture combined with chemocauterization is a safe and effective treatment of PSF. Surgery can be performed during the acute cervical inflammatory period without increased risk of complication or recurrence, however, patients found to have acute changes affecting the pyriform sinus should be treated with a staged surgery strategy.

A laser‐assisted endoscopic approach to pyriform sinus fistula via fibrin glue cauterization

In the past, the general treatment method for pyriform sinus fistula was its removal by open surgery; however, in recent years, endoscopic surgery has become more common. We report two cases where laser surgery was performed using an endoscope and recurrence was prevented using fibrin glue. Both cases involved 3-year-old girls who underwent laser ablation of a pyriform sinus fistula under an endoscope, after which the site was closed with fibrin glue. No recurrence was observed in either case, and the postoperative course was uneventful. This approach is presented as a non-invasive and effective treatment for pyriform sinus fistula.

Congenital pyriform sinus fistula in a child: Transoral semiconductor laser cauterization and closure by nonabsorbable suture using the ORBEYE exoscope

Pyriform sinus fistula (PSF) is a congenital disease derived from the remnants of the third or fourth branchial cleft. Until now, open neck surgery has been the main curative treatment, but recent years have seen reports of cases treated using endoscopic oral fistulectomy, chemocauterization, or ablation. We used the ORBEYE 4K 3-dimensional surgical microscope system (Olympus, Japan) to cauterize the fistula cavity with a semiconductor laser and to close the fistula opening with a monofilament non-absorbent thread. The use of the ORBEYE exoscope, with which a good view of the surgical field can be shared with all surgical staff, and which provides a sufficient working space, has rarely been reported for PSF surgery, but indications for PSF cases are expected to increase in the future with the adoption of such methods. In addition, laser ablation of the fistula lumen alone poses an initial risk of influx of infection sources after surgery, so closure of the opening with nonabsorbable thread was considered important for improving curability. •Some kinds of transoral treatment for pyriform sinus fistula have been reported. •Transoral laser surgery using ORBEYE is proved to be a useful method. •Closure of the opening with nonabsorbable suture can suppress the recurrence.

A preliminary study on low temperature plasma obliteration for pyriform sinus fistula by visual laryngoscope

Objective:To investigate the effect of low-temperature plasma obliteration for pyriform sinus fistula by visual laryngoscope. Methods:The clinical data of 29 cases with congenital pyriform sinus fistula receiving low temperature plasma obliteration by visual laryngoscope during March 2019 to August 2021 was retrospectively analyzed in department of Otolaryngology Head and Neck Surgery of Children's Hospital of Nanjing Medical University. Nineteen cases accepted the pyriform sinus fistula probing + fistula obliteration, 6 cases accepted the pyriform sinus fistula probing + fistula obliteration + neck abscess incision and drainage, and 4 cases with cervical abscess accepted the pyriform sinus fistula probing + fistula obliteration. Results:All cases had no obvious complications. Two cases had vocal cord impairment after operations and recovered after one month. There was no recurrence in 2 to 30 months follow up, with mean 16 months follow up. Conclusion:Low-temperature plasma obliteration of pyriform sinus fistula by visual laryngoscope is a safe and effective surgical method with little trauma and short hospital stay. It could be the first choice for the treatment of pyriform sinus fistula. Incision and drainage of neck abscess and pyriform sinus fistula obliteration could be performed concurrently.

Experience performing partial fistulectomy through a single incision to treat pyriform sinus fistula in children

Background and objectivesThe surgical treatment of pyriform sinus fistula (PSF) is improving. The aim of this study was to investigate the effect of partial fistula excision in children with PSF assisted by using methylene blue. MethodsAccording to the method used to treat PSF infection, the patients were divided into a conservative treatment group, a single incision group (the children drained the abscess through the incision at the dermatoglyph of the cricothyroid joint), and a non single incision group (the children drained the abscess through the incision in the most obvious area of the abscess or ulceration). The data were retrieved from the electronic medical records (EMRs) and hospital information system （HIS）. The patient and observer scar assessment scale (POSAS) scores at 6 months after fistula resection were compared. ResultsA total of 239 patients diagnosed with PSF underwent partial resection of the fistula through cervical approach with methylene blue. The success rate of the operation was 100%. The average operation time was 32 ± 13.2 min. The average hospital stay was 1 ± 0.2 days. There were 2 cases of transient hoarseness and 6 cases of wound infection. There were 17 patients in the conservative treatment group, 81 patients in the single incision group and 145 patients in the nonsingle incision group. The average POSAS scores of the three groups were 2.56 ± 0.6, 3.12 ± 0.84 and 4.56 ± 1.56, respectively, with significant differences among the three groups (P < 0.05). ConclusionsPartial fistulectomy assisted by using methylene blue through a single incision in the neck for the treatment of PSF in children yields a high success rate, fewer postoperative complications and greater comfort than traditional surgery. This alternative surgery can be used to treat PSF in children.

Microlaryngoscopic surgery for pyriform sinus fistulas in children: a report of two cases

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.

Misdiagnosic analysis and treatment of pyriform sinus fistula in children

Objective: To discuss the misdiagnosis of pyriform sinus fistula and to better understand this kind of illness. Methods: The analysis was based on twenty-eight patients with congenital pyriform sinus fistula aged from 11 months to 14 years, with the median age of 5 years, and who were surgically treated from January 2013 to January 2017 in Kunming Children's Hospital.Twenty patients were misdiagnosed in other hospital.After the routine examination of neck ultrasound and enhanced CT, internal fistula was found by self-retaining laryngoscope, traced by methylene blue, and excised by high ligation. Results: Twenty patients were misdiagnosed.The misdiagnosis time ranged from 6 months to 3 years.Under self-retaining laryngoscope, piriform fossa fistula were found in all patients.Nineteen fistula were found in the left and 1 in the right.The fistula in patients was unilateral.Seven cases were misdiagnosed as suppurative lymphadensitis, undergone abscess incisional drainage many times.Three cases were misdiagnosed as thyroglossal duct cyst and performed excision of thyroglossal duct cyst.One case was treated by extended Sistruck operation again because the doctor considered that excision of middle segment of hyoid bone was not enough and the fistula was not ligated completely.One case was misdiagnosed as second branchial cleft fistula on the right side of the neck.Nine cases were misdiagnosed as hyroid-associated diseases including 2 cases suppurative thyroiditis, 2 cases subacute thyroiditis and 5 cases thyroid neoplasms.Among them, 2 cases underwent partial thyroidectomy.All the patients were treated with high ligation of fistula under general anesthesia.The operation was smooth, and no hoarseness, bucking and pharyngeal fistula occurred after the operation.Postoperative follow-up time ranged from 12 months to 4 years and the median follow-up was 18 months without recurrence.The diagnosis was confirmed pathologically. Conclusions: Pyriform sinus fistula in children was uncommon and easily misdiagnosed in clinic.The majority of physician including some otolaryngologists were lack of understanding of the disease.It should be regarded as one of the important differential diagnosis of neck mass in children.Children with recurrent left neck infection and/or abscess should be highly suspected.Self-retaining laryngoscopic examination can make a definite diagnosis and high ligation of the fistula through the external neck approach can achieve good therapeutic effect.

Evaluation of endoscopic coblation treatment for obliteration of congenital pyriform sinus fistula

Background: Congenital pyriform sinus fistula is a very rare branchial apparatus malformation. Conventional open surgery for fistulectomy might fail to excise the lesion completely, leading to continual recurrence. The aim of this study was to provide an innovative endoscopic coblation technique for patients with pyriform sinus fistula and evaluate its intermediate-term effectiveness.Methods: Retrospective case series with 112 patients (age range 3–36 years) between 2013 and 2016 and underwent endoscopic coblation of the sinus fistula. Data collected including patient demographics, presenting symptoms, diagnostic methods, prior and subsequent treatments, length of hospital stay, and recurrence were analyzed.Results: Of the 112 cases, there were no postoperative complications observed except temporary reddish swelling in three patients. Four cases were lost to follow-up. Of 108 patients, 106 experienced no recurrence after their first endoscopic coblation of the sinus tract. The remaining two patients with recurrence in the follow-up were ultimately treated with recoblation without complications or further recurrences. Also, Endoscopic coblation can be used to treat seven patients with recurrence who had experienced open resection. In our series, median follow-up period was 1.5 years.Conclusion: Endoscopic coblation is an effective approach for most patients. We advocate using this minimally invasive technique as first line of treatment for pyriform sinus fistula.

Advances in endoscopic treatment of congenital pyriform sinus fistula in children

Pyriform sinus fistula is a rare clinical disease, often with recurrent acute suppurative thyroiditis or neck infection in children.The traditional method treatment is complete resection of the fistula with or without hemithyroidectomy in external cervical surgical approach, but in recent years, minimally invasive endoscopic occlusion of the internal opening for the treatment of pyriform sinus fistula is performed in many hospitals, including electrocautery, chemocautery, laser cauterization, biocauterization, and suture closure. Literatures about endoscopic management of pyriform sinus fistula in children are reviewed and various surgical methods, complications and success rate are evaluated.

Endoscopic electrocauterization of pyriform sinus fistula.

To determine the efficacy of endoscopic electrocauterization for pyriform sinus fistula (PSF) using a flexible Bugbee cautery electrode. From 2009 to 2016, a total of eight patients with acute suppurative thyroiditis or cervical abscess secondary to PSF were retrospectively registered in our study (three males, five females; median age 6.5years). All patients underwent endoscopic electrocauterization as treatment for PSF. Six of eight patients had no recurrence after the initial endoscopic electrocauterization of PSF. One patient with recurrence developed symptoms 9days after cauterization and another experienced recurrence after 2years. Mean follow-up for the eight patients was 50months (range 5-96months). No post-operative complication was reported. Endoscopic electrocauterization appears to be a less-invasive, safe, and effective method for the treatment of PSF.

The diagnosis and treatment for pyriform sinus fistula in children

Objective: To discuss the diagnosis and management for pyriform sinus fistula in children. Methods: Eight cases of pyriform sinus fistula admitted in Guangzhou Women and Children's Medical Center from May 2013 to August 2015 were retrospectively analyzed. The median age at onset was 54 months (range from 11 months to 12 years). All 8 cases presented recurrent neck infection (typical of redness, swelling, heat and pain) and 2 accompanied with acute suppurative thyroiditis. The diagnosis was confirmed by the preoperative barium esophagography combined with neck computed tomography scan (plain scan, enhancement and reconstruction). All the patients underwent laryngeal endoscopic-assisted surgery. Results: Preoperative imaging findings identified seven left-side cases and one bilateral (the symptom only manifested on left side). All 8 cases underwent left fistulectomy. There was no esophageal injury nor nerve injury during the operation. Postoperatively, all cases recovered well without complications (such as sound hoarse and coughing) and reoccurrence within the follow-up period (range from 7 months to 34 months). Conclusions: Preoperative barium esophagogram combined with neck computed tomography scan facilitates proper diagnosis and appropriate treatment. Laryngeal endoscopic-assisted technique at operation provides a better understanding of the anatomic relationship and the points where the fistulas penetrated into the pharynx, and essentially improves the operation outcome.

Preoperative identification of the internal opening with the modified Killian’s method in a case of pyriform sinus fistula

Pyriform sinus fistula is a rare branchial pouch anomaly, which causes recurrent neck abscess. Although complete excision of the fistula tract is considered as a definitive treatment for pyriform sinus fistula, it has been suggested that chemocauterization with trichloroacetic acid (TCA) of the internal opening is a reasonable treatment. For this purpose identifying the existence of an internal opening is important. Here, we describe the Modified Killian’s method, a recently proposed simple endoscopic technique to observe a wider area of the hypopharyngeal space, and show that it is helpful to identify the internal opening of the pyriform sinus fistula. The Modified Killian’s method is a suitable examination for pyriform sinus fistula prior to TCA chemocauterization.

Recurrent neck lesions secondary to pyriform sinus fistula.

Recurrent neck lesions associated with third or fourth branchial arch fistula are much less common than those of second arch and usually present with acute suppurative thyroiditis or neck abscess. Our aim is to describe clinical features, management and treatment outcomes of 64 cases of congenital pyriform sinus fistula (PSF). Medical record of these 64 patients (33 males, 31 females) treated at the First Affiliated Hospital of Zhengzhou University from 2011 to 2014 were reviewed. The patients comprised 33 males and 31 females, and their ages ranged from 18 months to 47 years (median 10 years, mean 12.7 years). Neck abscess and recurrent infection was the mode of presentation in 37 cases (57.8 %), 4 patients (6.3 %) presented with acute suppurative thyroiditis, neck mass was the mode of presentation in 17 cases (26.6 %), 2 patients (3.1 %) presented with neck mass with respiratory distress, and cutaneous discharging fistula was the mode of presentation in 1 cases (1.6 %). The remaining 3 patients (4.7 %) presented with cutaneous discharging fistula with neck infection. Investigations performed include barium swallow, CT scan, and ultrasound which were useful in delineating PSF tract preoperatively. Barium swallow was taken as the gold standard for diagnosis. Our patients were treated by fistulectomy with hemithyroidectomy, fistulectomy, fistulectomy with endoscopic electric cauterization, endoscopic electric cauterization or endoscopic coblation cauterization, respectively. Histopathologic examination of the surgical specimens revealed that they were lined with ciliated epithelium, stratified cuboid epithelium with chronic inflammatory cell infiltration and fibrosis. Voice hoarseness occurred after operation in seven patients, but disappeared 1 week later. PSF recurred in 6 patients, 4 of them were cured by a successful re-excision. One patient was cured by successful endoscopic electric cauterization. The other 1 has remained asymptomatic for 5 months. In our series, mean follow-up period was 13.3 months and median follow-up period was 12.5 months (range 2-40 months). Presence of congenital PSF should be suspected when intra-thyroidal abscess formation occurs as the gland is resistant to infection. Strong clinical suspicion, barium swallow study, CT scan and ultrasound are the key to diagnosis. Both fistulectomy with hemithyroidectomy and endoscopic treatment have comparable success rate. Endoscopic coblation cauterization may prove a useful and equally effective method of treatment for PSF in future.

A Case of Pyriform Sinus Fistula Concurrent with Papillary Thyroid Carcinoma in a 72-Year-Old Patient

Since branchial anomalies are developmental disorders, pyriform sinus fistula (PSF) has been considered as a pediatric disease, and most reports of PSF with clinical symptoms have thus been on neonatal and young children. There are only a few case reports worldwide, of PSF found in adult patients. Here, we report a case where the patient’s initial symptom of PSF occurred at the age of 72. Interestingly, papillary thyroid carcinoma (PTC) was concurrently identified on computed tomography during the evaluation for PSF. Chemical cauterization and total thyroidectomy was performed for the treatment of PSF and PTC, respectively. This case report may contribute to increased awareness of PSF in adult patients and the possible coexistence of thyroid cancer in these patients.

Chemocauterization of the internal opening with trichloroacetic acid as first‐line treatment for pyriform sinus fistula

Pyriform sinus fistula is a rare brachial pouch anomaly. However, it is difficult and risky to remove the fistula tract completely. Circumferential chemocauterization of the internal opening with trichloroacetic acid (TCA) for pyriform sinus fistula is simple, reproducible, reliable, and causes less morbidity. The aim of this study was to determine the feasibility of TCA chemocauterization for pyriform sinus fistula. This retrospective study enrolled 44 patients who were diagnosed with pyriform sinus fistula and underwent TCA chemocauterization. We retrospectively reviewed the medical records of the patients to obtain their demography as well as treatment outcomes for them. The success rate of treatment for pyriform sinus fistula after the first TCA chemocauterization was 77.3% (34/44) and the cumulative success rate after the second treatment was 93.2% (41/44). There was no complication such as vocal fold palsy after TCA chemocauterization. It is suggested that TCA chemocauterization can be a reasonable first-line treatment for pyriform sinus fistula.

トリクロール酢酸による化学焼灼を施行した梨状陥凹瘻の４例

Pyriform sinus fistula is a relatively rare disease that causes recurrent neck abscess. Radical treatment for this disease involves extirpation of the fistula; however, the physical and emotional stress caused by the surgery is sometimes not well tolerated by patients, especially small children. Thus, it is important to pursue the possibility of other trearment strategies. Recently, it is suggested that chemocauterization of the internal opening of the fistula is a safe and effective mode of management of pyriform sinus fistula. We reviewed four cases (two boys and two girls, aged 5 to 7 years) with pyriform sinus fistula treated with trichloroacetic acid (TCA) chemocauterization during the period from 2002 through 2007 at Nippon Medical School. By direct endoscopy, the opening of fistula in the left pyriform sinus was easily detected. There were no intraoperative or postoperative complications. In two of the four patients, it was not necessary to incise the neck to drain the abscess as they were managed with antibiotics and chemocauterization. Oral feeding was started within the first 2 days postoperatively. Only one of the four patients had a recurrent neck abscess, which was managed by extripation of neck granulation and repeated TCA chemocauterization. Our experiences suggest that TCA chemocauterization is a relatively safe, simple and useful mode of treatment for pyriform sinus fistula especially in children. The appropriate concentration of TCA, indications for using this mode of treatment and the long term prognosis remain to be determined.

A new role for computed tomography in the diagnosis and treatment of pyriform sinus fistula

Neck abscess located in or around the thyroid gland should raise the suspicion of acute suppurative thyroiditis, pyriform sinus fistula, a 3rd or 4th branchial cleft anomaly. Differentiating between these entities on a clinical basis is difficult. After treating the initial infection, computed tomography, barium esophagography, ultrasound, and endoscopy can be used in search of the fistulous tract that can be associated with a pyriform sinus fistula or a 3rd or 4th branchial anomaly. We present a case of a pyriform sinus fistula involving the use of oral contrast, combined with computed tomography, to delineate the tract and its surrounding structures. This method, in combination with endoscopy, aided in the removal of this branchial anomaly. (Am J Otolaryngol 2000;21:323-325. Copyright © 2000 by W.B. Saunders Company)

Surgical strategy for the treatment of pyriform sinus fistula.

Surgical strategy for the treatment of pyriform sinus fistula.

Surgical strategy for the treatment of pyriform sinus fistula

Pyriform sinus fistula recurs when a complete excision of the fistula has not been made. As a supportive technique for this radical operation, the authors performed an intraoperative endoscopic examination of the pyriform sinus for the cannulation or dye injection of the tract in four cases. In three cases, the sinuses were relatively long and ran outside the thyroid cartilage. The cannulation of the tract with a guide wire, in these cases, was useful for identifying the thin membranous tract. In one of these three cases sinus fistula recurred, but a complete excision of the tract was then performed by introducing a 10F Nelaton catheter over a guide wire, which allowed for easy handling of the remnant tract. In the remaining case, cannulation proved not to be useful because the tract was short and ran inside the thyroid cartilage. A short tract embedded within the inferior constrictor muscle could only be found through careful observation after repeated dye injections. The proper selection of the optimum supportive techniques as described above, are considered to be essential for performing a complete excision.