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Recurrent deep neck abscess and piriform sinus tract: a 15-year review on the diagnosis and management

Jennifer W C Mou1, Kin Wai Chan1, Yuen Shan Wong1

  • 1Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.

Journal of Pediatric Surgery
|August 6, 2014
PubMed

Insights

Piriform sinus tract (PST) diagnosis in children is often delayed, causing recurrent inflammation. Contrast swallow studies are effective but best performed after acute inflammation subsides, with fistulectomy being a successful treatment.

Area of Science:

  • Pediatric Surgery
  • Otolaryngology
  • Congenital Abnormalities

Background:

  • Piriform sinus tract (PST) is a rare congenital anomaly.
  • Delayed diagnosis of PST is common, leading to recurrent inflammation and complications.

Purpose of the Study:

  • To review the diagnosis and treatment of piriform sinus tract (PST) in children.
  • To evaluate the effectiveness of diagnostic imaging and surgical interventions for PST.

Main Methods:

  • Retrospective review of 18 pediatric patients with PST treated between May 1997 and May 2012.
  • Analysis of diagnostic methods including contrast swallow study, ultrasonography, and CT scans.
  • Review of surgical outcomes, including fistulectomy and hemithyroidectomy.

Main Results:

  • Most patients (88.9%) presented with acute inflammation, predominantly on the left side (16 patients).
  • Contrast swallow study identified 72.2% of PST cases, with higher diagnostic yield after acute inflammation resolved.
  • Median diagnostic delay was 17.6 months, with 55.6% experiencing recurrent inflammation before diagnosis. Fistulectomy alone was successful in most cases.

Conclusions:

  • PST should be suspected in children with left-sided deep neck abscesses.
  • Contrast swallow study is a valuable diagnostic tool for PST, best performed after acute inflammation subsides.
  • Fistulectomy is an effective treatment for PST, often avoiding the need for hemithyroidectomy.
Abstract

Keywords:
Acute Suppurative ThyroiditisBranchial RemnantDeep Neck AbscessPiriform Sinus FistulaPiriform Sinus Tract

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