Bilateral Piriform sinus fistulas: A case study and review of management options

Abstract

BackgroundPiriform sinus fistulas occur due to developmental abnormalities of the third and fourth branchial arches, and almost always occur unilaterally. They generally present as recurrent abscesses in the anterior-inferior neck, with concurrent thyroiditis. They have conventionally been managed with complete removal of the sinus tract, and thyroidectomy if required; however, endoscopic approaches have been increasingly favored. Herein we describe a case of bilateral piriform sinus fistulas, and present a review of the literature concerning their endoscopic management.Case presentationOur patient was determined to have bilateral piriform sinus fistulas based on computer tomography, magnetic resonance imaging and microlaryngoscopy. We performed electrocauterization of the proximal fistula tracts, followed by injection of fibrin sealent. Our patient has not had a recurrence in the ten months since his procedure. There were no complications.Twenty-three articles describing an endoscopic approach to these fistulas were identified through PubMed, and a search through the references of related articles was completed.ConclusionOf one hundred and ninety-five patient cases we reviewed, an endoscopic procedure success rate of 82% and complication rate of 5.6% was determined. Piriform sinus fistulas that occur bilaterally are a rare congenital abnormality of the neck. Endoscopic approaches are an acceptable alternative option to open procedures, with similar success and a lower rate of complications.

MRI in Children With Pyriform Sinus Fistula

“…17,18 In our study there were 11 right-sided CPSF, which is the largest cohort. Bilateral CPSF 18,19 are extremely rare and there was no bilateral CPSF in our study. The maleto-female ratio was 59:56.…”

A Rare and Challenging Case of Neck Infection - Thyroid Abscess

“…Thyroid lobectomy may be needed in cases where extensive necrosis develops, or if the infection persists (as evidenced by leucocytosis, continued fever, and progressive signs of local inflammation) despite adequate antibiotics [ 10 ]. Alternative endoscopic approaches are acceptable, with similar success and a lower rate of complications [ 13 ].…”

Congenital fistula of the fourth branchial arch: Report of case with long‐lasting misdiagnosis

“…Recently, endoscopic chemocauterization with TCA of the sinus/fistula tract has been described, with similar results and recurrence rate than open neck surgery. 6,12,13 While the endoscopic approach might avoid a neck scar to the patients, we believe open neck resection remains the treatment of choice for recurrent and previously operated cases. Malformations of the branchial arches are extremely common, especially of the second arch.…”

“…Differential diagnosis of a cystic lateral neck mass includes thymic, parathyroid and thyroid cysts, cystic metastases (papillary thyroid carcinoma, oropharyngeal squamous cell carcinoma), tuberculous cold abscess, or laryngoceles . Surgical excision is the standard of care, whereas electro or chemical cauterization is therapeutic alternatives …”

“…4,5 Surgical excision is the standard of care, whereas electro or chemical cauterization is therapeutic alternatives. 6 Fourth branchial arch anomalies are extremely rare and almost always occur on the left side. 7 Misdiagnosis is common, and repeated incision and drainage yield high rates of recurrence.…”