Microlaryngoscopic surgery for pyriform sinus fistulas in children: a report of two cases

Abstract

BackgroundA pyriform sinus fistula (PSF) is a rare branchial anomaly that causes recurrent cervical infections. Open neck surgery has widely been accepted as a definitive treatment for PSFs, and endoscopic surgery has been reported in recent years. However, both approaches are not satisfactory because of high recurrence rates and postoperative complications. Microlaryngoscopic surgery (MLS) is a transoral surgical technique involving the use of an operating microscope. In this report, we present a new procedure involving MLS for resection and closure of a PSF without a skin incision.Case presentationTechnique: MLS was performed under general anesthesia with endotracheal intubation. The patient was placed in the supine position, and a direct laryngoscope was inserted to expose the pyriform sinus, which was then magnified using an operating microscope. The mucosal layer was carefully resected using scissors and cupped forceps with sharp edges. The fistula was securely sutured using absorbable suture material. Case 1: A 9-year-old boy with recurrent neck abscesses since 8 years of age presented to our hospital after receiving antibiotics and undergoing drainage in other hospitals. After admission to our hospital, barium esophagography and oral contrast coronal computed tomography showed a PSF on the left side, and open neck surgery was performed to resect the fistula. He was eventually discharged from the hospital without any problem. However, a PSF recurred 2 weeks later. As reoperation with the cervical approach was considered difficult owing to severe adhesions, we adopted MLS as a definitive operation. The postoperative course was uneventful. No recurrence was observed during an 18-month follow-up. Case 2: A 10-year-old girl presented to our hospital with recurrent left-sided neck swelling since 6 years of age. After inflammation control, a PSF was identified on the left side on barium esophagography and computed tomography. MLS was performed safely, and the postoperative course was uneventful. No recurrence was observed during a 10-month follow-up.ConclusionsMLS allows excellent visualization and effective closure for PSFs, and this approach is suitable for recurrence after open neck surgery. Therefore, MLS might become a first-line treatment for PSFs in children.

Endoscopic Suture With Chemocauterization: An Effective Treatment of Congenital Pyriform Sinus Fistula

“…While Kamide et al 20 and Koyama 21 reported that the normal hypopharyngeal mucosa was sutured following fistula resection. Nomura et al 22 also reported 2 fistulas were securely sutured using absorbable suture material under microlaryngoscopic surgery. Our double suture could increase the thickness of mucosa in order to enhance wound healing.…”

The treatment of congenital pyriform sinus fistula: a single-center experience

“…With the development of technology and popularization of minimally invasive surgery, endoscopic surgery is less invasive and exhibits a better cosmetic effect compared with open neck surgery. A few reports have advocated electrocautery, chemical cautery, and other strategies for the treatment of CPSF [5,6], which are less invasive and hardly produce a cutaneous scar. Nevertheless, these methods are imperfect so far, as their recurrent rates are higher than the complete resection approach [19].…”

“…The recurrent infection and previous surgery usually destroy the surrounding normal anatomies, making it dangerous to eradicate the tract [2,3]. Over the past few years, there has been increasing interest in treating CPSF using endoscopic obliteration or cauterization as the primary treatment [5,6], and hence, open surgery is no longer compulsory. However, in some cases, relapses are unavoidable due to incomplete closure of the tract opening and/or remainder of the fistula epithelial lining.…”

Intraoperative Nursing Cooperation in Endoscopy-Assisted Surgery of Pyriform Sinus Fistula in Chinese Children: Experience in 196 Cases

“…At present, complete resection of fistula is still the most common and thorough treatment for PSF (1,2,6,15,16). However, in a review of 177 published reports on PSF, 377 patients who underwent open surgery, 15% recurrence occurred after initial surgery, the same as under endoscopic cauterization.…”

“…Radical resection of fistula after resolution of inflammation is the key to avoid recurrence. However, it is difficult to find the fistula in traditional open-neck surgery, or the resection is incomplete, which may lead to recurrence (1,6). In recent years, minimally invasive endoscopic occlusion of the internal opening for the treatment of PSF is performed, including biocauterization (7), electrocautery (8), chemocautery (9), coblation (10), laser cauterization (11), and suture closure (6), etc.…”