Korean J Otorhinolaryngol-Head Neck Surg.  2013 Mar;56(3):154-158. 10.3342/kjorl-hns.2013.56.3.154.

Pyriform Sinus Fistula: A Single Center Experience

• Seok JH
• Ahn D
• Sohn JH
• Choi JH
• Jung YY
• Kong JS

• KMID: 2277875
• DOI: http://doi.org/10.3342/kjorl-hns.2013.56.3.154

Abstract

BACKGROUND AND OBJECTIVES
Pyriform sinus fistula with 3rd and 4th branchial cleft anomaly is an extremely rare congenital condition that is not very well understood owing to its rarity. The aim of the study was to review our experience with pyriform sinus fistulae to better understand them.
SUBJECTS AND METHOD
Of 163 patients with branchial anomaly treated at our institute between 1999 and 2011, medical records of 15 patients with pyriform sinus fistula were retrospectively reviewed.
RESULTS
Overall, 9.2% had pyriform sinus fistulae and this proportion was higher than that of patients with 1st branchial anomaly. The mean age at the time of initial symptom presentation was 11.9 years. However, five patients (33.3%) were not diagnosed at that time because pyriform sinus fistula was not suspected. Computed tomography (CT) was the most sensitive diagnostic tool in patients suspected to have pyriform sinus fistulae; the sensitivity of CT was 86.7%, whereas that for esophagography was only 20%. Conservative surgical treatment involving cauterization of the opening of the fistula tract was performed in nine patients and showed favorable results with 22.2% of recurrence rate during a mean follow-up period of 23.1 months. In 67.7% of the patients, the causative organisms were bacteria inhabiting human mouth, suggesting that infection source for pyriform sinus fistula may be food contents and discharge of upper aerodigestive tract.
CONCLUSION
The incidence of pyriform sinus fistula may be higher than expected. Therefore, the possibility of pyriform sinus fistulae coexisting should be considered while treating young patients with perithyroidal infection.

Keyword

Branchial cleft anomalies; Fistula; Pyriform sinus; Trichloroacetic acid

MeSH Terms

Bacteria
Branchial Region
Craniofacial Abnormalities
Fistula
Follow-Up Studies
Humans
Incidence
Medical Records
Mouth
Pharyngeal Diseases
Pyriform Sinus
Recurrence
Retrospective Studies
Trichloroacetic Acid
Branchial Region
Craniofacial Abnormalities
Pharyngeal Diseases
Trichloroacetic Acid