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Objectives: Congenital pyriform sinus fistula (CPSF) is a rare disease that can be easily misdiagnosed. This study investigates the value of ultrasonography in the early diagnosis and treatment of CPSF in children., Methods: Clinical features and ultrasonography images of 31 CPSF pediatric patients confirmed by operation were retrospectively analyzed, different sonographic features during the infection period and the quiescence period were summarized and the consistency test of ultrasonic recognition and diagnosis between observers was conducted., Results: In this study, 25 CPSF children had thick-walled cystic masses during the infection period, and cystic masses of 8 cases showed gas echo inside; after the modified valsalva maneuver, gas echo was found in another 5 cases. The detection rate of gas can be enhanced through the modified valsalva maneuver and infants' cry so as to provide an important basis for the diagnosis of pyriform sinus fistula. During the quiescent period of inflammation of 6 cases, fistula can be completely shown, and the wall structure has not been completely destroyed, so that the running position of fistula can be clearly seen. Ultrasonography boasted a good inter-observer consistency in identification and determination (Kappa:0.799-0.857; P<0.001)., Conclusion: Ultrasonography could clearly reveal the position and direction of CPSF fistula. Different ultrasonic characteristics in different periods could provide relevant information for the selection of clinical operation timing and evaluate the post-operative effects., Competing Interests: The authors declare that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Objective: 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., Study Design: Retrospective study., Setting: Tertiary referral center., Methods: Retrospective case review of patients treated between March 2012 and June 2021 at our institution with descriptive statistical analysis., Results: 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 CO 2 laser cauterization; other patients only had a history of repeat incision and drainage or 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., Conclusion: 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., (© 2023 The Authors. Otolaryngology-Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology-Head and Neck Surgery Foundation.)

Objective: To explore the clinical value of recurrent laryngeal nerve dissection in the surgical treatment for congenital pyriform sinus fistula（CPSF）. Methods: The clinical data of 42 patients with CPSF were retrospectively analyzed. All patients were diagnosed and treated in the First Affiliated Hospital of Guangdong Pharmaceutical University. Results: During the operation, all patients' recurrent laryngeal nerves were dissected successfully, and fistulas were resected completely,no patients had complication of recurrent laryngeal nerve's damage.There were no recurrence cases during the 13 to 48 months of follow-up. Conclusion: The trend of congenital pyriform sinus fistula is closely related to recurrent laryngeal nerve, it's important to dissect the recurrent laryngeal nerve during the operation for congenital pyriform sinus fistula., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objectives: Obliteration with cauterization of the internal opening of pyriform sinus fistulas, with or without marsupialization, has been a mainstay for preventing recurrence. However, this procedure predisposes patients to recurrence caused by the reopening of the cauterized orifice. We applied suture ligation to secure the closure of the internal orifice following cauterization and evaluated treatment., Methods: A total of 42 patients were diagnosed with third or fourth branchial cleft anomaly with internal pyriform sinus fistula and treated either with cauterization or with cauterization and suture ligation, between January 2008 and December 2020. The medical records were reviewed to assess demographic characteristics, clinical presentations, diagnoses, surgical treatment, and outcomes. Treatment flow characteristics for intractable patients were analyzed., Results: The median age of onset was 9 years (range, 0-57 years). Neck swelling (n = 32, 76.2%) was commonly encountered symptom, and a history of neck infection was found in 27 patients (64.3%). After initial treatment, 11 cases (56.2%) recurred. Younger age (≤9 years) and thyroid involvement were associated with recurrence ( P  = .034 and P  = .046, respectively). Cauterization with suture ligation presented lower recurrence rate (19.2%) than cauterization only (37.5%, P  = .037). Cauterization with suture ligation for recurrent cases (n = 11) showed 81.8% (9/11) of cure rate. Intractable fistulas (n = 2) from both groups were also salvaged by suture ligation., Conclusions: Suture ligation with cauterization for an internal orifice of branchial anomaly showed lower recurrence rate than cauterization only. This method was beneficial for refractory cases.

Background and Objectives: The 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., Methods: According 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., Results: A 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)., Conclusions: Partial 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., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Pyriform sinus fistula (PSF) is a rare branchial pouch anomaly of the neck that presents a diagnostic and management challenge. The objective of this study is to highlight the value of intraoperative suspension laryngoscope-assisted methylene blue injection through the internal opening as a guide for locating the fistula., Methods: A retrospective study of 70 cases of PSF in children from 2009 to 2017 was managed, and an intraoperative suspension laryngoscope-assisted method combined with neck exploration and excision of the tract were performed in all cases., Results: The patients comprised 36 males and 34 females ranging in age from 7 days to 15 years. Sixty-four cases were predominantly left-sided (64/70, 91.4%), and 6 cases (6/70, 8.6%) occurred on the right side. Four cases exhibited temporary postoperative hoarseness (4/70, 5.7%), which disappeared after one week. There were no instances of recurrence during follow-up ranging from two to nine years, and the median follow-up period was four years., Conclusion: The use of our surgical approaches can facilitate the localization of the fistula during dissection in open neck surgery, and reduce recurrence., (Copyright © 2021. Published by Elsevier B.V.)

Objectives: The purpose of this study is to explore the curative effect of open surgical excision and endoscopic radiofrequency ablation (RA) in the treatment of piriform fossa fistula (PSF)., Methods: Retrospective study of 80 cases of PSF in the Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, from June 2009 to June 2017., Results: In this series, there were 43 males and 37 females, and the mean age was 5.2 years (17 days to 12 years). Surgical excision was performed for 62 patients. Radiofrequency ablation was performed for 18 patients. Six cases of postoperative temporary hoarseness occurred, and the hoarseness rates were not significantly different between the excision and RA groups (6.4% vs 11.1%, respectively, P = .88). Two cases of temporary neck abscess occurred in the RA group. After the mean follow-up period of 3.1 years (1-8 years), no recurrence was found between the excision and RA groups., Conclusions: The curative effect of excision and RA for PSF is not significantly different; each of the 2 methods has its advantages and disadvantages. However, RA for PSF has the merit of being minimally invasive, easy to operate, and safe; this procedure seems to be more suitable in the clinic.

Background: Acute suppurative thyroiditis through the congenital pyriform sinus fistula (PSF) often recurs if the fistula is not resected. Although endoscopic chemo-cauterization (ECC) to obliterate the orifice of the fistula is less invasive than open fistulectomy, it may require repeated treatments. We recently adopted an endoscopic diode laser-cauterization (ELC) system with the intention of improving treatment outcomes in PSF. Here, we describe ELC and compare the outcomes of these three modalities., Methods: We evaluated 83 patients with PSF who underwent treatment between 2007 and 2018 at Kuma Hospital, a tertiary thyroid treatment hospital. ECC and ELC were implemented in 2007 and 2015, respectively. Patients who were ineligible for the endoscopic procedures underwent open fistulectomy. Barium swallow studies and computed tomography scan under a trumpet maneuver were performed after treatment to evaluate obliteration or removal of the fistula., Results: In total, 70 of the 81 (86%) patients who underwent barium swallow studies after the first treatment achieved obliteration or removal of the fistula. The success rates for open fistulectomy, ECC, and ELC were 100% (9/9), 83% (49/59), and 100% (13/13), respectively. ECC and ELC had significantly shorter operative times and lower blood loss than open fistulectomy. Insufficient opening of the mouth was the major reason for converting endoscopic procedures to open fistulectomy., Conclusions: ELC may yield superior outcomes and is therefore the optimal treatment modality for PSF. However, it is still associated with certain limitations. Thus, treatment selection remains dependent on the shape and size of the PSF and the mouth opening of the individual patient., (© 2021. The Author(s).)

Objective: To compare the efficacy, advantages and disadvantages of endoscopic CO 2 laser cauterization (ECLC) and open neck surgery in the treatment of congenital pyriform sinus fistula (CPSF). Methods: From September 2014 to March 2017, 80 cases with confirmed diagnosis of CPSF received initial treatment at Guangdong Provincial People's Hospital were prospectively analyzed, including 34 males and 46 females, aged 18 to 672 (194.17±141.18) months. They were consecutively divided into endoscopic group and open-surgery group, with 40 cases in each group. Both groups of patients received surgical treatment under general anesthesia. The endoscopic group was treated by endoscopic CO 2 laser cauterization, and the open-surgery group underwent the following surgery: first, we performed suspension laryngoscopy examination to confirm the presence of fistula in the bottom of the piriform fossa, then open-neck resection of congenital piriform sinus fistula with recurrent laryngeal nerve and/or lateral branch of superior laryngeal nerve anatomy plus partial thyroidectomy were performed. The data between the two groups were compared, including the operative time, intraoperative blood loss, postoperative pain, average length of stay, neck cosmetic scores, complications and cure rates. All patients were followed up in outpatient clinics. Statistical analysis was performed using SPSS 20.0 software. P<0.05 indicates that the difference is statistically significant. Results: All patients were successfully completed the operation. The operative time, intraoperative blood loss, postoperative pain and average length of hospital stay in the endoscopic group were significantly less than those in the open group [(27.4±5.5) min to (105.8±52.5) min, (0.6±0.5) ml to (33.6±41.5) ml, (1.7±0.9) points to (4.6±0.7) points, (5.9±2.9)d to(8.9±3.3)d, t values were-9.400, -5.031, -16.199, -4.293, P values were all<0.01]; The neck cosmetic score in the endoscopy group was significantly greater than that of the open group [(9.9±0.4) against (5.8±0.9) points, t =25.847, P <0.01]. Compared with the open group (15.0%, 6/40), the complication rate of the endoscopic group (7.5%, 3/40) was not statistically significant (χ²=0.50, P >0.05). Three months after the first treatment, the cure rate in the endoscopic group (82.5%, 33/40) was significantly lower than that in the open-neck group (100.0%, 40/40), χ²=5.64, P <0.05. The follow-up time was 12 months after the last treatment. Eighty cases were followed up and none was lost to follow-up. During the follow-up period, the cure rate of the endoscopy group (97.5%, 39/40) was compared with that of the open group (100.0%, 40/40), and the difference was not statistically significant. Conclusions: In the treatment of CPSF, the two-surgical method each has their advantages. Compared with open-neck surgery, ECLC is simpler, repeatable. ECLC has shorter time in operation and hospital stay, less complications, and less postoperative pain and more precise cosmetic results. It could be preferred for the initial treatment of CPSF and relapsed cases after cauterization. But subject to relatively low cure rate of one-time cauterization and uncertain long-term efficacy, it cannot completely replace the open-neck surgery at present.

Objective: Suppurative acute thyroiditis is caused by pyriform sinus fistula (PSF), and PSF frequently elicits deep neck abscess. However, complete fistulectomy is the ideal management of PSF, and studies on surgical findings of PSF are exceedingly rare. This study aimed to reveal the origins of PSF, each route, and clinical presentation., Methods: This is a multicenter study. We have conducted 19 complete fistulectomies of PSF in Japan, analyzed routes of the fistulas, estimated the origins, and investigated their histological and clinical findings., Results: No recurrence was observed in all cases. Five of 12 cases showed thymic and/or parathyroid tissues around the fistulas, passing inside the inferior horn of thyroid cartilage, were regarded as having 3rd pouch origin, and tended to have low frequency of severe deep neck abscess. The remaining 7 cases originated from the 4th pouch running outside of the horn and showed frequent severe infection., Conclusion: PSF have 2 different routes depending on their generation and may present different clinical manifestations.

Abstract: Congenital pyriform sinus fistula (CPSF) is a very rare branchial apparatus malformation. Traditional open surgery for fistulectomy might fail to excise the lesion completely, leading to continual recurrence. Herein, we report our experience of endoscopic coblation technique for treatment of CPSF in children.To observe the clinical efficacy of endoscopic coblation treatment of CPSF in children, especially for those in acute infection stage.Retrospective case series with 54 patients (including 20 cases in acute infection stage and 34 cases in non infection stage) who were diagnosed with CPSF between October 2017 to November 2019, all patients were treated with endoscopic coblation to close the piriform fossa fistula, neck abscess incision and drainage performed simultaneously for acute infection stage cases. Data collected including age of diagnosis, presenting symptoms, diagnostic methods, prior and subsequent treatments, length of hospitalization, and recurrence were analyzed.Of the 20 cases in acute infection stage, there were 3 children with transient vocal cord paresis all of which resolved with 1 month. Four children of the 34 cases in non infection stage appeared reddish swelling of the neck on the 4th, 5th, 6th, and 7th days after coblation and then underwent abscess incision and drainage. All cases experienced no recurrence, vocal cord paralysis, pharyngeal fistula and massive hemorrhage after their first endoscopic coblation of the sinus tract in the follow up of 3 to 28 months.Endoscopic coblation is an effective and safe approach for children with CPSF, neck abscess incision and drainage could be performed simultaneously in acute infection stage. We advocate using this minimally invasive technique as first line of treatment for CPSF., Competing Interests: The authors have no conflicts of interests to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: To discuss the diagnosis and treatment of congenital pyriform sinus fistula（CPSF） in newborn. Methods: Clinical data of 5 patients with CPSF innewborn were reviewed and the clinical symptoms, auxiliary examinations, surgical methods were analyzed after the operation, patients were followed up closely at different stages. Results: All the 5 neonates successfully completed the surgery without pharyngeal fistula, dysphagia, perifistula and distal fistula infection. Follow-up survey ranged from 3 months to 2 years and no one recurred. Conclusion: Neonatal CPSF is a rare disease with a short course of disease and rapid progression. In severe cases, it may threaten life and should be treated in time., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Background: Pyriform sinus fistula (PSF) is a rare congenital anomaly, and the preferred definitive treatment is yet to be verified. In this study, we investigated the treatment outcomes of PSF specifically comparing endoscopic-assisted surgery and endoscopic radiofrequency ablation (RA)., Methods: The medical records of patients treated for PSF at the Shanghai Children's Hospital between October 2016 and September 2019 were retrospectively evaluated., Results: There were 93 girls and 98 boys. The median age at onset and operation was 3 years and 5 years, respectively. Endoscopic-assisted surgery was performed in 143 patients. During the same period, RA was performed in 48 patients, and 10 of them concurrently underwent incision and drainage of neck abscesses. Longer hospital stay was found in the endoscopic-assisted surgery group than in the RA group (10.50 ± 3.93 vs. 5.02 ± 3.30 days, P < 0.001). Postoperative complications were not significantly different between the two groups, except for neck infection (0 vs. 8.3%, P = 0.004). After a median follow-up period of 21 months, no significant difference was found between the two groups in terms of recurrence (1.4% vs. 0, P = 0.560)., Conclusion: Patients treated with RA had a significantly shorter hospital stay than those treated with endoscopic-assisted surgery. Outcomes of endoscopic-assisted surgery and RA were not significantly different for the management of PSF and treatment method should be tailored to the patient., Level of Evidence: IV., (Copyright © 2020. Published by Elsevier Inc.)

Pyriform sinus fistula (PSF) is a rare congenital entity. We hypothesized that clinical features, diagnosis and treatment may differ between newborns and children. 190 patients diagnosed with PSF were divided into two groups: neonatal (n = 15) and childhood (n = 175). The medical records including demographic and clinical data were retrospectively analyzed. There were 102 boys and 88 girls in this study. Most patients presented as a left-sided neck lesion. A neck mass, with or without infection and respiratory distress, was the common finding in newborn patients. Prenatal diagnosis was made in three cases. However, in childhood group, initial symptoms were neck abscess (78.8%), acute thyroiditis (11.4%), neck mass (6.9%), and thyroid lesion (2.8%). The presence of a cervical mass with air pocket showed on CT image was thought to be the pathognomonic finding of neonatal PSF. The diagnosis was usually established by barium esophagography in older children. Delayed accurate diagnosis was detected in both groups. The median time from onset to diagnosis was 22 months and 1 year respectively. Endoscopic-assisted open surgery was performed successfully in all patients, with good outcomes in majority cases of both groups (93.3% and 95.4%). Recurrence was developed in 5 patients. PSF should be suspected in newborns with cervical mass and in children with recurrent neck infection, especially on the left side. Early diagnosis and treatment might avoid repeated surgical procedures. Complete resection of the cyst and fistula in non-infected state is essential for good outcomes.

Objective: To observe the clinical efficacy of lowtemperature plasma minimally invasive treatment of piriform fossa fistula in children at the infection stage and non-infection stage. Method: Twenty-five pediatric patients of piriform fovea fistula were treated with low-temperature plasma minimally invasive treatment. These patients were divided into the infection stage group(16 cases) and the non-infection stage group(9 cases). In both groups, low-temperature plasma ablation was performed to close the piriform fossa fistula under laryngoscope supported by endotracheal intubation under general anesthesia. For patients in infection stage, simultaneous cervical abscess incision and drainage were performed. The efficacy, postoperative recurrence rate and complications of the two groups were compared. Result: In the non-infection stage group, 7 cases were cured by 1 operation, and 2 cases were cured by the reoperation. In the infection stage group, 10 cases were cured by 1 operation, 5 cases were cured by the reoperation, and 1 case was cured by external fistula resection due to repeated purulent discharge of neck infection. No recurrent laryngeal nerve injury, massive hemorrhage or other complications occurred in these patients. Conclusion: Low temperature plasma minimally invasive treatment is safe and effective for pediatric patients of piriform fossa fistula., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To discuss the clinical anatomic characteristics of congenital pyriform sinus fistula and summarize the experiences of open neck surgery. Method： The clinical data of 12 patients with congenital pyriform sinus fistula were retrospectively analyzed. Result: During the operation, all lesions were located below of superior laryngeal nerve. All fistulas were closely related with the supperior part of thyroid gland and laterally passed over the left recurrent laryngeal nerve just before merging into the apex of piriform sinus or beginning of aesophagus. Follow-up periods were ranging between 8 to 65 months. Two months after surgery,one patient showed lateral neck abscess again. After open drainage procedures and antibiotics treatment, there was no recurrence signs during 3 years of follow-up. Conclusion: We found that the congenital pyriform sinus fistula was closely related to the superior thyroid gland and recurrent laryngeal nerve,which was different from the popular theory.We had not encountered types descending into mediastinum and thoracic cavity or ascending along common carotid artery sheath. All fistulas passed over the left recurrent laryngeal nerve，and then merged into the apex of pyriform sinus or beginning of aesophagus.The key point for successful resection of fistulas in block was to remove the superior involvement part of the thyroid gland and exposure the recurrent laryngeal nerve. Based on our practical findings, the neck dissection procedure should not be taken in some patients that the anatomical structure is not clear for repeated infections., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Recurrent thyroid infections are rare in children. When present, patients should be evaluated for anatomic anomalies such as pyriform sinus fistulae. We describe a 12-year-old girl with history of recurrent thyroid abscesses secondary to a pyriform sinus fistula and managed with concurrent endoscopic ablation and incision and drainage.

Objective: To describe clinical presentations, management and treatment outcomes of 17 cases of congenital pyriform sinus fistula (PSF) of third branchial arch origin presenting as left recurrent acute suppurative thyroiditis with cervical abscess., Method: Medical record of these 17 cases (5-males, 12-females) presented during 2009-2013 were reviewed., Results: Average age was 9.6 years (range 3-15 years). Fistulous opening in neck was present in 10 cases (58.8%). Average number of episode of infection from first presentation to definitive diagnosis was 3 (range 2-5). All patient had history of incision and drainage (ID) of abscess (average 2, range 1-3). All cases had barium swallow and CT scan. Sixteen cases had telescopic hypopharyngoscopy. Barium swallow and telescopic hypopharyngoscopy detected PSF in 88.23% (15/17) and 100% (16/16) cases respectively. Fourteen cases were treated by transcervical excision (TE) (fistulectomy with left hemithyroidectomy), two cases were treated by endoscopic chemical cauterization (ECC) of internal opening at pyriform sinus using silver nitrate and only ID of abscess was done in one case. Success rate of TE and ECC was 93% and 100% respectively. Recurrence in one case initially treated by TE was managed successfully by ECC., Conclusion: Presence of congenital PFS should be suspected when left-sided intra-thyroidal abscess formation occurs as gland is resistant to infection. Strong clinical suspicion, barium swallow study, telescopic pharyngoscopy and CT scan are the key to diagnosis. Both TE and ECC has comparable success rate. ECC may prove a useful and equally effective method of treatment for congenital PFS in future., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: To evaluate the effectiveness of endoscopic CO₂ laser cauterization (ECLC) as a definitive treatment of congenital pyriform sinus fistula (CPSF)., Methods: Eleven patients with CPSF underwent ECLC between January 2011 to March 2013 at Guangdong General Hospital. Of the 11 patients aging from 20 to 672 months (median: 60 months), there were 4 males and 7 females; 10 lesions located in the left necks and 1 located in the right; 6 untreated previously and 5 recurrent; 10 sinus (with internal opening) and 1 fistula. The presentations included reduplicative neck swelling, pain, or a fistulous opening with purulent discharge at the anterior neck region. Preoperative examinations included barium esophagogram, CT, MRI and so on. Six patients had at least received one time incision and drainage procedure previously. All patients had been treated with antibiotics in acute infection period. After inflammation subsided, the openings of pyriform sinus fistula were confirmed by esophagoscopy and then ECLC on internal opening was routinely performed.Esophagoscopy was carried out again by 3 months later in every patient, the same technique would be performed immediately if the internal opening was not completely closed., Results: The existence of an orifice in the pyriform fossa was identified by esophagoscopy in 11 patients. In 9 patients, the treatment was successful and the internal opening completely closed after the first ECLC. However, the other 2 patients received the second cauterization 3 months later because of the incomplete close of the internal opening. The average number of treatments was 1.2 times. No complications such as dysphagia, hoarseness occurred with the endoscopic procedure. Both the patients and their families were satisfied with the cervical appearance. All the patients had an uneventful recovery and remained no symptom from 11 to 35 months (median: 24 months)., Conclusion: The endoscopic CO₂ laser cauterization is safe, effective, repeatable and minimally invasive, which can be suggested as first-line treatment for congenital pyriform sinus fistula.

Purpose: Pyriform sinus fistula (PSF) is often overlooked, and presents diagnostic and management challenge. The aim of this study was to highlight the value of intraoperative endoscopy-assisted intubation or methylene blue injection through the internal opening as a guide in searching for the fistula., Methods: The charts of 48 patients diagnosed with PSF during January 1990 until January 2013 were retrospectively reviewed. The records were analyzed for sex, side of lesion, age at onset/diagnosis, initial presentations, diagnostic methods, microbiologic cultures, pathologic findings, treatments and outcomes., Results: There were 22 males and 26 females, with a median age at onset and diagnosis of 2 years (range, 8 months to 9 years) and 4 years (range, 12 months to 13 years), respectively. The lesions were predominantly left sided (93.7%). The most common presentation was neck abscess (62.5%). Other presentations were acute suppurative thyroiditis/thyroid abscess (7), neck mass with or without dyspnea (9), and thyroid nodule (2). Barium esophagography showed the sinus tract in 100% cases. The positive predictive value of other modalities was oral-contrast CT 88.9%, intravenous contrast-enhanced CT 53.8%, noncontrast CT 33.3%, and sonography 7.9%. Thyroid function were reported normal in most tested cases (14/15, 93.3%). The fistula tract was lined with pseudostratified squamous epithelium or ciliated columnar epithelium, often associated with inflammatory changes. Bacteria cultured from the discharge were found to be oral flora. Partial thyroidectomy was operated on 11 cases. Two patients (2/8, 25%) who underwent open surgery without endoscopic assistance exhibited recurrence, while no recurrence was noted in children with the help of intraoperative endoscopy. Postoperative results were good in majority (93.7%)., Conclusion: PSF should be considered in any children with repeated neck or thyroid infection/mass. The combination of barium esophagography, CT scan and ultrasound is useful to establish the diagnosis. Intraoperative endoscopy-assisted intubation or methylene blue injection through the internal opening as a guide can facilitate identification of the tract during dissection., (© 2014.)

Background: 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., Methods: 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., Results: 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., Conclusions: It is suggested that TCA chemocauterization can be a reasonable first-line treatment for pyriform sinus fistula., (Copyright © 2012 Wiley Periodicals, Inc.)

Objective: Acute suppurative neck infections associated with third or fourth branchial arch fistulas are frequently recurrent. Third and fourth branchial arch anomalies are much less common than those of second arch and usually present with left thyroid lobe inflammation. The authors present their experience with 15 cases of pyriform sinus fistulae (PSF) of third branchial arch origin and 3 cases of fourth arch origin, all of which presented as recurrent neck infection mainly on the left side., Methods: A retrospective review of 18 cases of third and fourth arch fistulae treated at JIPMER from 2005 to 2010. This study includes 18 patients with PSF diagnosed by the existence of fistulous tract radiologically and intraoperatively with pathological correlation. Neck exploration with excision of tract and left hemithyroidectomy was performed in all cases., Results: The patients consisted of 7 males and 11 females, and the ages ranged from 3 to 15 years. All of them presented with recurrent episodes of neck infection. Investigations performed include computed tomography (CT) fistulography, barium swallow and ultrasound which were useful in delineating pyriform sinus fistulous tract preoperatively. All cases were on the left side and the fistula was identified by barium swallow in 14 cases (80%), while intraoperative and pathologic confirmation of the tract was possible in all cases (100%). Neck exploration with an emphasis on complete exposure of the recurrent laryngeal nerve and exposure of the pyriform sinus opening to facilitate complete fistulous tract excision with left hemithyroidectomy was successful in all patients. A follow up period of 1-3 years showed no recurrence., Conclusion: Recurrent neck infection in a child should alert the physician to the possibility of an underlying pyriform sinus fistula of branchial origin and CT fistulography should be performed after the resolution of the neck infection to delineate the tract anatomically., (Crown Copyright © 2011. Published by Elsevier Ireland Ltd. All rights reserved.)