Endoscopic chemical cautery of piriform sinus tracts: a safe new technique

Piriform sinus tracts are thought to be of branchial origin and typically present with suppurative thyroiditis or a lateral neck mass. Endoscopic examination with direct visualization of the internal opening usually confirms the diagnosis. Complex external surgery with complete excision of the tract is the current standard of care. We report two cases of piriform sinus tracts which were managed with silver nitrate cautery of the internal opening. Post-operative closure of the opening was confirmed in one patient. This appears to be a safe and effective technique that eliminates the need for surgery and has not been previously reported.