Objective To investigate the anatomical characteristics of congenital piriform sinus fistula (PSF) in children, and design a minimally invasive surgical method. Method From July 2012 to July 2018, 54 cases of PSF were divided into two groups. In the traditional group the thyroid or external fistula plane approach was adopted in 34 patients, while in modified group the inferior horn of thyroid cartilage approach was adopted in 20 patients. The anatomical characteristics about PSF were then studied. The following data were compared and analyzed between the two groups: the incision length, surgical duration, intraoperative blood loss, hospitalization length, the rate of radical operation, complication and postoperative recurrence. Results Fistula was divided into infundibular and transitional parts. Infundibular was located behind or on the side of the posteroinferior cornu. Fistula had three types. Type I had terminal at the upper pole of the thyroid, Type II had terminal reaching the skin via the thyroid, and Type III had terminal reaching the skin directly. The incision length, surgical duration, intraoperative bleeding, hospitalization length and recurrence rate in the modified group were lower than those in the traditional group (P<0.01). After following-up of 6~18 months, the recurrence rate was 29.4% in the traditional group, but no recurrence was found in the modified group. Conclusion Piriform fossa fistulectomy is performed through posteroinferior cornu with advantages such as short operation path, quick recovery, and low recurrence rate. It is a better choice in management of PSF owing to its safety and effectiveness.
Key words
Pyriform sinus fistula /
Thyroid cartilage /
Child /
Cervical abscess
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] Abbas PI, Roehm CE, Friedman EM, et al. Successful endoscopic ablation of a pyriform sinus fistula in a child: case report and literature review[J]. Pediatr Surg Int, 2016, 32(6): 623-627.
[2] Lu WH, Feng L, Sang JZ, et al. Various presentations of fourth branchial pouch sinus tract during surgery[J]. Acta Otolaryngol, 2012, 132(5): 540-545.
[3] Derks LS, Veenstra HJ, Oomen KP, et al. Surgery versus endoscopic cauterization in patients with third or fourth branchial pouch sinuses: a systematic review[J]. Laryngoscope, 2016, 126(1): 212-217.
[4] Josephson GD, Black K. A review over the past 15 years of the management of the internal piriform apex sinus tract of a branchial pouch anomaly and case description[J]. Ann Otol Rhinol Laryngol, 2015, 124(12): 947-952.
[5] Nicoucar K, Giger R, Pope HG Jr, et al. Management of congenital fourth branchial arch anomalies: a review and analysis of published cases[J]. J Pediatr Surg, 2009, 44(7): 1432-1439.
[6] 刘涛, 温哲, 梁奇峰, 等. 儿童梨状窝瘘的诊断和治疗[J]. 中华医学杂志, 2016, 96(39): 3156-3159.
[7] 桑建中, 路武豪, 娄卫华, 等. 先天性梨状窝瘘管的诊断与治疗[J]. 中华耳鼻咽喉头颈外科杂志, 2011, 46(9): 728-732.
[8] Piccioni M, Bottazzoli M, Nassif N, et al. Intraoperative use of fibrin glue dyed with methylene blue in surgery for branchial cleft anomalies[J]. Laryngoscope, 2016, 126(9): 2147-2150.
[9] Madana J, Yolmo D, Gopalakrishnan S, et al. Complete congenital third branchial fistula with left-sided, recurrent, suppurative thyroiditis[J]. J Laryngol Otol,2010, 124(9): 1025-1029.
[10]Xiao X, Zheng S, Zheng J, et al. Endoscopic-assisted surgery for pyriform sinus fistula in children: experience of 165 cases from a single institution[J]. J Pediatr Surg, 2014, 49(4): 618-621.
