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A novel and efficient surgical procedure for pyriform sinus fistulas in children
Jiarui Chen1, Ying Wang1, Chenling Shen1
1Department of Otorhinolaryngology-Head & Neck Surgery, Shanghai Children's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Insights
A novel surgical approach for pediatric pyriform sinus fistulas (PSF) using the external cervical route through the hypopharynx demonstrated high efficacy. This method offers a safe and effective treatment with a low recurrence rate in children.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Surgical Innovation
Background:
- Pyriform sinus fistula (PSF) is a congenital anomaly requiring surgical intervention.
- Previous treatments like endoscopic surgery have limitations, especially for recurrent cases or those with visible scars.
Purpose of the Study:
- To evaluate the efficacy of a novel surgical procedure for pediatric pyriform sinus fistulas.
- To assess the safety and outcomes of the external cervical approach through the hypopharynx for PSF treatment.
Main Methods:
- Retrospective analysis of 71 pediatric patients with PSF treated between 2012 and 2022.
- Surgical intervention via the external cervical approach with hypopharyngeal access.
- Dye instillation through the internal opening for precise tract identification.
Main Results:
- All 71 patients had internal orifices located in the pyriform sinus.
- Only two patients experienced temporary hoarseness, which resolved within 3 months.
- No major complications such as parapharyngeal abscess or incision infection were observed; no recurrence was noted during follow-up (23-70 months).
Conclusions:
- The novel external cervical approach through the hypopharynx is an effective surgical treatment for pediatric PSF.
- This method offers advantages including a short operative path, rapid recovery, minimal complications, and a low recurrence rate.
- It is particularly beneficial for recurrent PSF cases and patients with prior cervical surgical scarring or masses.
Objective:
This study aims to evaluate the efficacy of a novel surgical procedure for pyriform sinus fistulas in children via the external cervical approach through the hypopharynx.
Methods:
A retrospective analysis was conducted on 71 pediatric patients with pyriform sinus fistula (PSF) who underwent treatment at the Department of Otolaryngology Head and Neck Surgery, Shanghai Children's Hospital, from 2012 July to 2022 July. Surgical treatment of PSF was performed via the external cervical approach through the hypopharynx, with dye instilled through the internal opening to serve as a guide for tract identification.
Results:
All the internal orifices were found in the pyriform sinus by direct laryngoscopy in all 71 patients under general anesthesia. Two patients had a postoperative temporary hoarseness that resolved after 3 months. The other patients had no complications such as parapharyngeal abscess and incision infection. All patients were followed up for 23 months-70 months, and no recurrence was found.
Conclusion:
The novel surgical procedure of PSF performed via the hypopharynx has advantages such as a short operation path, quick recovery, fewer complications, and a low recurrence rate. This method is a better choice for managing recurrence cases after repeated cauterization endoscopic surgeries, as well as for patients with visible cervical surgical scars or masses.
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