Differences in the characteristics and management of pyriform sinus fistula between neonates and young children

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Published on: November 30, 2010

Hizuru Amano1, Hiroo Uchida, Kaori Sato

  • 1Department of Pediatric Surgery, Saitama Children's Medical Center, 2100 Magome, Iwatsuki, Saitama, Saitama, 339-8551, Japan.

Pediatric Surgery International
|October 20, 2011
PubMed

Insights

Pyriform sinus fistula (PSF) presents differently in neonates versus young children. Neonatal PSF involves large cysts and respiratory distress, while older children experience neck pain and thyroiditis, impacting management strategies.

Area of Science:

  • Otolaryngology
  • Pediatric Surgery
  • Congenital Anomalies

Background:

  • Pyriform sinus fistula (PSF) is a rare congenital anomaly arising from branchial pouch remnants.
  • Clinical presentation varies, with neonates often showing respiratory distress due to large cervical cysts, and older children presenting with lateral neck infections or suppurative thyroiditis.

Purpose of the Study:

  • To investigate and compare the distinct clinical characteristics and management approaches for pyriform sinus fistula (PSF) in neonates versus young children.

Main Methods:

  • Retrospective review of hospital records for neonatal and young children's groups diagnosed with PSF between January 2002 and December 2010.
  • Analysis of differences in presenting symptoms, diagnostic imaging, and operative findings between the two age groups.

Main Results:

  • Twelve PSF cases were identified.
  • Neonatal PSF typically featured a wide pyriform sinus orifice and large cysts, facilitating guide wire insertion.
  • Young children with PSF presented with cervical pain and suppurative thyroiditis, and smaller fistula openings made supportive cannulation challenging.

Conclusions:

  • Distinct etiological differences exist between neonatal and young children's pyriform sinus fistulas.
  • Direct visualization of the pyriform fossa, including possible incision of the inferior pharyngeal constrictor muscle, is a valuable technique for complete PSF resection when supportive cannulation fails.
Abstract

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