Successful management of pyriform sinus cyst and fistula using endoscopic electrocauterization

Abstract

Objectives Pyriform sinus cyst (PSC) and pyriform sinus fistula (PSF) is a rare congenital malformation that arises from the third or fourth branchial structure. In our study, we describe the safety and the utility of endoscopic electrocauterization against PSC/PSF. Methods We retrospectively reviewed the records of patients who underwent endoscopic electrocauterization for PSC/PSF at our hospital. The internal opening of the fistula was identified under general anesthesia using a flexible endoscope (XQ‐260 or H‐290; Olympus, Tokyo, Japan), and the DualKnifeJ (KD‐655L; Olympus) was used to ablate the internal opening. Results We experienced three PSF and three PSC patients. The postoperative course was uneventful in all cases. The patients declared no pain in the neck, and there were no cases showing recurrent nerve paralysis. Five in six cases (83%), the closure of fistula was archived in the first cauterization. One case (16.6%) required repeated cauterization. No recurrence was found during the follow‐up period ( median: 1 year) in any cases. Conclusions Owing to its rarity in neonates, the diagnosis and treatment of PSC remains complicated and not clearly described. Complete removal of the fistula and the cyst with or without affected thyroid tissue was previously the most commonly used treatment. From our experience, we believe that endoscopic electrocauterization can be the first choice not only for PSF but also for neonatal PSC. In conclusion, endoscopic electrocauterization is feasible even for neonatal PSC. Further investigations including multicenter analyses are needed.

Minimally Invasive Management of Neonatal Piriform Fossa Sinus Tract: A Scoping Review

“…Table I outlines the demographic and clinical features of the 21 neonates 1,6–13 . Most studies were case reports.…”

“…This was performed either through percutaneous cyst aspiration, via endoscopic pharyngeal swelling aspiration, or decompression through the sinus opening (7/21, 33.3%). Sclerotherapy with OK‐432 was used as part of the initial management in two neonates 13 and as a second or third intervention in three additional neonates employing tetracycline 12 or bleomycin (case presented here).…”

“…US-guided percutaneous aspiration of the neck cyst or direct endoscopic pharyngeal swelling aspiration of the sinus tract contents are both valid treatment options for neck swelling. In recent reports, injection sclerotherapy has been used, 12,13 with agents such as OK-432 (3 patients), tetracycline (2 patients), and bleomycin, as in the case treated at our institution. The precise mechanism of sclerotherapy is not entirely understood, but the common goal is to induce local cystic inflammation, and eventual fibrosis and scarring.…”

“…Table I outlines the demographic and clinical features of the 21 neonates. 1,[6][7][8][9][10][11][12][13] Most studies were case reports. Mean age at onset of symptoms was 11.6 days (AESD 11.1, range 1-18 days).…”