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[Diagnosis and management of piriform sinus fistulae in children]
Insights
Piriform sinus fistula is a common cause of acute suppurative thyroiditis in children. Early diagnosis and surgical intervention, like fistulectomy, lead to successful outcomes and prevent recurrence.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Endocrinology
Context:
- Piriform sinus fistula is a rare congenital anomaly.
- Acute suppurative thyroiditis in children is often linked to underlying branchial anomalies.
- This study investigates the clinical presentation and management of piriform sinus fistula in pediatric patients.
Purpose:
- To highlight the association between piriform sinus fistula and acute suppurative thyroiditis.
- To evaluate the diagnostic methods and treatment outcomes for piriform sinus fistula.
- To emphasize the clinical significance of understanding this rare branchial anomaly.
Summary:
- Twelve pediatric patients (1.5-10 years) with piriform sinus fistula were studied.
- Most presented with left thyroid lobe inflammatory swelling, diagnosed via ultrasonography, scintigraphy, and barium swallow.
- Surgical management (fistulectomy, cystectomy) resulted in good outcomes; conservative management showed varied results with one recurrence.
Impact:
- Early recognition of piriform sinus fistula is crucial for managing acute suppurative thyroiditis in children.
- Surgical treatment offers a definitive solution with low recurrence rates.
- Improved understanding of this anomaly can guide clinical practice and improve patient management.
Abstract:
In 12 patients with piriform sinus fistula, aged from 1.5 to 10 years all but one patient presented themslves with inflammatory swelling in the region of the left lobe of the thyroid gland. During acute infection, the involvement of the left thyroid lobe was verified by ultrasonography and scintigraphy. Barium swallow examination was the diagnostic finding that all the 11 patients had a left-sided fistula. One patient presented with a painless cyst in the left thyroid lobe. Six patients operated on 4 underwent fistulectomy. In patient the fistula was not found. In the patient who had a cyst in the thyroid lobe, fistulectomy and cystectomy were done. All these patients did well postoperatively without recurrence. Six other patients were followed up without operation with in 1-6 years. Five patients remained asymptomatic. One patient had 3 recurrences during a 2 years follow-up period. Piriform sinus fistula is the most common underlying abnormality in the patients with acute suppurative thyroiditis. A better understanding about this rare branchial anomaly is of clinical importance.