Endoscopic coblation treatment for congenital pyriform sinus fistula in children

Abstract

Congenital pyriform sinus fistula (CPSF) is a very rare branchial apparatus malformation. Traditional open surgery for fistulectomy might fail to excise the lesion completely, leading to continual recurrence. Herein, we report our experience of endoscopic coblation technique for treatment of CPSF in children. To observe the clinical efficacy of endoscopic coblation treatment of CPSF in children, especially for those in acute infection stage. Retrospective case series with 54 patients (including 20 cases in acute infection stage and 34 cases in non infection stage) who were diagnosed with CPSF between October 2017 to November 2019, all patients were treated with endoscopic coblation to close the piriform fossa fistula, neck abscess incision and drainage performed simultaneously for acute infection stage cases. Data collected including age of diagnosis, presenting symptoms, diagnostic methods, prior and subsequent treatments, length of hospitalization, and recurrence were analyzed. Of the 20 cases in acute infection stage, there were 3 children with transient vocal cord paresis all of which resolved with 1 month. Four children of the 34 cases in non infection stage appeared reddish swelling of the neck on the 4th, 5th, 6th, and 7th days after coblation and then underwent abscess incision and drainage. All cases experienced no recurrence, vocal cord paralysis, pharyngeal fistula and massive hemorrhage after their first endoscopic coblation of the sinus tract in the follow up of 3 to 28 months. Endoscopic coblation is an effective and safe approach for children with CPSF, neck abscess incision and drainage could be performed simultaneously in acute infection stage. We advocate using this minimally invasive technique as first line of treatment for CPSF.

Pediatric bronchogenic cysts in the head and neck region: A study of 10 surgical cases and a review of the literature

“…The first branchial cleft anomalies (CFBCAs) often presented with repeated swelling and purulence in Pochet's triangle. CT showed round, tubular or strip-shaped abnormal the thyroid and air-containing ducts originating from the piriform fossa (23,24). It was difficult to distinguish this disease from other diseases by preoperative imaging alone (8).…”

“…The main clinical manifestations of CPSF are recurrent suppurative thyroiditis and neck abscess, predominantly located on the left sided ( 22 ). CT revealed the shallower or disappearing pyriform sinus, large cystic lesion with fluid and air, association or obscuration of the left superior thyroid lobe with the neck mass or abscess, tubular structures seen inside the thyroid and air-containing ducts originating from the piriform fossa ( 23 , 24 ).…”

A laser‐assisted endoscopic approach to pyriform sinus fistula via fibrin glue cauterization

“… 8 There are also reports showing the effectiveness of endoscopic coblation as a first‐line treatment for PSF. 9 There is still a risk of fistula recurrence if only its surface is cauterized. 10 A method of preventing recurrence by absorbing suture after cauterizing a pear or fistula with a laser was presented.…”

A safe and effective surgical method for complex pyriform sinus fistula

“…However, this conventional surgery is challenging and results in large incisions with obvious postoperative scars. Complications and recurrence can also occur 6,7 . These outcomes can greatly affect a patient's quality of life and even cause great discomfort.…”

“…Complications and recurrence can also occur. 6 , 7 These outcomes can greatly affect a patient's quality of life and even cause great discomfort.…”