Pyriform Sinus Fistula: A Single Center Experience

Received February 5, 2013 Revised March 7, 2013 Accepted March 8, 2013 Address for correspondence Dongbin Ahn, MD Department of OtolaryngologyHead and Neck Surgery, Kyungpook National University Medical Center, 807 Hoguk-ro, Buk-gu, Daegu 702-210, Korea Tel +82-53-200-5777 Fax +82-53-423-4524 E-mail godlikeu@naver.com Background and ObjectivesZZPyriform sinus fistula with 3 and 4 branchial cleft anomaly is an extremely rare congenital condition that is not very well understood owing to its rarity. The aim of the study was to review our experience with pyriform sinus fistulae to better understand them. Subjects and MethodZZOf 163 patients with branchial anomaly treated at our institute between 1999 and 2011, medical records of 15 patients with pyriform sinus fistula were retrospectively reviewed. ResultsZZOverall, 9.2% had pyriform sinus fistulae and this proportion was higher than that of patients with 1st branchial anomaly. The mean age at the time of initial symptom presentation was 11.9 years. However, five patients (33.3%) were not diagnosed at that time because pyriform sinus fistula was not suspected. Computed tomography (CT) was the most sensitive diagnostic tool in patients suspected to have pyriform sinus fistulae; the sensitivity of CT was 86.7%, whereas that for esophagography was only 20%. Conservative surgical treatment involving cauterization of the opening of the fistula tract was performed in nine patients and showed favorable results with 22.2% of recurrence rate during a mean follow-up period of 23.1 months. In 67.7% of the patients, the causative organisms were bacteria inhabiting human mouth, suggesting that infection source for pyriform sinus fistula may be food contents and discharge of upper aerodigestive tract. ConclusionZZThe incidence of pyriform sinus fistula may be higher than expected. Therefore, the possibility of pyriform sinus fistulae coexisting should be considered while treating young patients with perithyroidal infection. Korean J Otorhinolaryngol-Head Neck Surg 2013;56:154-8