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Objective:To explore the clinical value of recurrent laryngeal nerve dissection in the surgical treatment for congenital pyriform sinus fistula（CPSF）. Methods:The clinical data of 42 patients with CPSF were retrospectively analyzed. All patients were diagnosed and treated in the First Affiliated Hospital of Guangdong Pharmaceutical University. Results:During the operation, all patients' recurrent laryngeal nerves were dissected successfully, and fistulas were resected completely,no patients had complication of recurrent laryngeal nerve's damage.There were no recurrence cases during the 13 to 48 months of follow-up. Conclusion:The trend of congenital pyriform sinus fistula is closely related to recurrent laryngeal nerve, it's important to dissect the recurrent laryngeal nerve during the operation for congenital pyriform sinus fistula.
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Humans , Neck , Recurrent Laryngeal Nerve/surgery , Retrospective Studies , Pyriform Sinus/surgery , Fistula/surgeryABSTRACT
Objective:To explore the curative effects of individualized surgical method for treating pyriform sinus fistula (PSF) in children.Methods:A total of 43 PSF children treated in the Department of Pediatric Surgery of Henan Provincial People′s Hospital from June 2015 to November 2019 were selected, with 41 cases on the left side and 2 cases on the right side.There were 27 cases in the quiescent inflammatory infection stage and 16 cases in the acute inflammatory infection stage.According to patients′ condition, low-temperature plasma radiofrequency ablation, fistulectomy, abscess incision and drainage or combined operation were conducted.The postoperative complications and recurrence were observed.Results:Among 43 cases, there were 19 cases treated with low-temperature plasma radiofrequency ablation, 11 cases treated with low-temperature plasma radiofrequency ablation combined with abscess incision and drainage, 5 cases treated with low-temperature plasma radiofrequency ablation combined with fistulectomy, and 8 cases treated with fistulectomy.Four cases had postoperative hoarseness and recovered within 1-5 months.One case occurred pseudo healing after abscess incision and drainage, and healed after incision and debridement.Totally, 4 cases recurred, and the follow-up time was from 3 months to 57 months.Conclusions:Low-temperature plasma radiofrequency ablation has the advantages of minimally invasive, safe and effective, which provides a new treatment for PSF in children.Based on the condition of children, the choice of individualized treatment can significantly improve the curative effects.
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ABSTRACT Objective There is currently no consensus regarding the optimal management of acute suppurative thyroiditis (AST) secondary to pyriform sinus fistula (PSF). To investigate the benefits and adverse events of aspiration with or without lavage for the treatment of AST secondary to PSF. Subjects and methods This was a retrospective analysis of consecutive patients with AST secondary to PSF who were admitted at the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University between August 2012 and December 2018. Clinical information, procedural data, and imaging data were analyzed. Results Seven patients (five women; mean age, 16.9 ± 6.3 years; range, 8-26 years) were included. The patients most presented with anterior neck pain and swelling (n = 7), fever (n = 7), or odynophagia (n = 5). Six cases of AST occurred on the left side of the thyroid and 1 on the right. All patients had thyroid abscess. AST was diagnosed by ultrasound-guided needle aspiration cytology in all cases. PSF was diagnosed during the inflammatory stage in five patients and during the quiescent stage in two. All patients were treated with empiric antibiotics. Needle aspiration without lavage was performed in three cases. Needle aspiration with lavage was performed in four cases. Repeat aspiration was performed in three cases. All patients recovered completely, with no procedure-related complications. During 18.3 ± 7.8 months of follow-up, AST recurred in one case. Excision of the PSF was performed in another case. Conclusion Ultrasound-guided aspiration with or without lavage had a good treatment effect and without adverse events for the management of AST secondary to PSF.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Young Adult , Thyroiditis, Suppurative/therapy , Pyriform Sinus/pathology , Fistula/complications , Thyroiditis, Suppurative/etiology , Thyroiditis, Suppurative/diagnostic imaging , Acute Disease , Retrospective Studies , Fistula/diagnostic imagingABSTRACT
Objective To evaluate the value of barium esophagography and CT in the diagnosis of congenital pyriform sinus fistula (CPSF).Methods The preoperative radiographic data of 5 9 CPSF patients were analyzed retrospectively,which were confirmed by operation.5 5 patients underwent barium esophagography,and 5 7 patients underwent pre-and post-contrast CT scans.The images of barium esophagography and CT were analyzed and the positive diagnostic rates (PDR)between the two imaging modalities and among the different CT features were compared.Results Among the 5 9 patients,left fistula was found in 5 5 cases,right fistula was found in 2 cases and bilateral fistula in 2 cases.For the patients examined with barium esophagography,53 sinus tracts or fistulas from the pyriform in 52 patients(including 2 patients with bilateral fistula)were depicted.The other 3 patients had negative results.The overall PDR of barium esophagography was 93.0%(53/57).CT findings of CPSF included the narrowness of pyriform fossa,sinus tract or fistula in the neck,bubble sign medial to the superior pole of thyroid,low density in thyroid,thyroid morphologic change,and so on.For the 5 7 patients (including 2 patients with bilateral fistula)examined with CT.The PDR of narrowness of pyriform fossa was 44.1%(26/59),the PDR of sinus tract or fistula was 1 3.6%(8/5 9),the PDR of bubble sign medial to the superior pole of thyroid was 55.9%(33/5 9),the PDR of low density in thyroid was 1 6.9%(1 0/5 9),the PDR of thyroid morphologic change(defect sign of superior pole of thyroid)was 9 1.5%(54/5 9 ).And the total PDR of thyroid density or morphologic change was 94.9%(56/59).Conclusion Barium esophagography can be the main modality to diagnose CPSF because of its high PDR.Although the PDR of CT for direct sign(sinus tract or fistula)is not high,its PDR for indirect sign (thyroid density or morphologic change)is very high.So CT has great value for patients suspected of CPSF.
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@#Though notorious for its tendency to induce recurrent neck abscess, pyriform sinus fistula is of importance despite its rarity. It usually presents diagnostic and therapeutic challenges. Because of post-infectious fibrosis, the embryologic origin of pyriform sinus fistula is difficult to appreciate in certain cases. Here we present a case with empyema and mediastinal abscess caused by pyriform sinus fistula and share our experience in the treatment of this patient.
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Objective@#To investigate the anatomic tract of congenital pyriform sinus fistula (CPSF).@*Methods@#A total of 90 patients with CPSF undergoing open surgery between August, 2007 and March, 2017 at the Department of Guangdong General Hospital were retrospectively analyzed.@*Results@#The tracts of all the fistulas actually walked far different from those of theoretical ones. A whole fistula may be divided into 4 segments according to adjacent anatomy of CPSF. The posterior inner segment to the thyroid cartilage was initial part of the fistula. It originated from the apex of pyriform sinus, then piercing out of the inferior constrictor of pharynx inferiorly near the inferior cornu of the thyroid cartilage (ICTC), and descended between the lateral branch of the superior laryngeal nerve and the recurrent laryngeal nerve. The ICTC segment was the second part of the fistula, firstly piercing out of the inferior constrictor of pharynx and/or cricothyroid muscle, and then entering into the upper pole of thyroid. The relationship between fistula and ICTC could be divided into three types: type A (medial inferior to ICTC) accounting for 42.2% (38/90); type B (penetrate ICTC) for 3.3% (3/90); and type C (lateral inferior to ICTC) for 54.5% (49/90). The internal segment in thyroid gland was the third part of fistula, walking into the thyroid gland and terminating at its upper pole (92.2%, 83/90) or deep cervical fascia near the upper pole of thyroid (7.8%, 7/90). The lateral inferior segment to thyroid gland was the last part of the fisula, most of which are iatrogenic pseudo fistula, and started from the lateral margin of thyroid gland.@*Conclusions@#CPSF has a complicated pathway. Recognition of the tract and adjacent anatomy of CPSF will facilitate the dissection and resection of CPSF in open surgery.
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Objective@#To evaluate the imaging features, clinical presentation, operative methods complication and the surgical outcomes of the congenital pyriform sinus fistula(CPSF). @*Methods@#The clinical data of 185 patients with CPSF treated from January 2013 to October 2017 at the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively. @*Results@#The lesions were predominantly on the left side(170/185). Among 185 cases, 146 cases received endoscopic coblation cauterization, 27 cases had traditional open surgery, 8 cases underwent endoscopic coblation cauterization plus traditional open surgery, 2 cases for endoscopic chemocauterization, and 2 cases for endoscopic electrosection. Twenty-eight cases recurred, with a recurrence rate of 15.1%. Postoperative hoarseness occurred in 22 cases, disappeared within 0.5-6.0 months later. @*Conclusions@#Patients with a history of recurrent cervical abscess should be highly suspect the existence of CPSF. Endoscopic coblation cauterization is a kind of surgical method with minimal injury, with low recurrence rate and low operative risk.
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Objective@#To discuss the misdiagnosis of pyriform sinus fistula and to better understand this kind of illness.@*Methods@#The analysis was based on twenty-eight patients with congenital pyriform sinus fistula aged from 11 months to 14 years, with the median age of 5 years, and who were surgically treated from January 2013 to January 2017 in Kunming Children′s Hospital.Twenty patients were misdiagnosed in other hospital.After the routine examination of neck ultrasound and enhanced CT, internal fistula was found by self-retaining laryngoscope, traced by methylene blue, and excised by high ligation.@*Results@#Twenty patients were misdiagnosed.The misdiagnosis time ranged from 6 months to 3 years.Under self-retaining laryngoscope, piriform fossa fistula were found in all patients.Nineteen fistula were found in the left and 1 in the right.The fistula in patients was unilateral.Seven cases were misdiagnosed as suppurative lymphadensitis, undergone abscess incisional drainage many times.Three cases were misdiagnosed as thyroglossal duct cyst and performed excision of thyroglossal duct cyst.One case was treated by extended Sistruck operation again because the doctor considered that excision of middle segment of hyoid bone was not enough and the fistula was not ligated completely.One case was misdiagnosed as second branchial cleft fistula on the right side of the neck.Nine cases were misdiagnosed as hyroid-associated diseases including 2 cases suppurative thyroiditis, 2 cases subacute thyroiditis and 5 cases thyroid neoplasms.Among them, 2 cases underwent partial thyroidectomy.All the patients were treated with high ligation of fistula under general anesthesia.The operation was smooth, and no hoarseness, bucking and pharyngeal fistula occurred after the operation.Postoperative follow-up time ranged from 12 months to 4 years and the median follow-up was 18 months without recurrence.The diagnosis was confirmed pathologically.@*Conclusions@#Pyriform sinus fistula in children was uncommon and easily misdiagnosed in clinic.The majority of physician including some otolaryngologists were lack of understanding of the disease.It should be regarded as one of the important differential diagnosis of neck mass in children.Children with recurrent left neck infection and/or abscess should be highly suspected.Self-retaining laryngoscopic examination can make a definite diagnosis and high ligation of the fistula through the external neck approach can achieve good therapeutic effect.
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Resumen Introducción: Las fístulas del seno piriforme, originadas desde el tercer o cuarto arco branquial, son entidades poco frecuentes. Se pueden presentar como aumento de volumen cervical, fístula cervical, absceso cervical, tiroiditis abscedada y/o disfonía. Objetivo: Reportar 4 casos tratados en nuestro hospital y revisión de la literatura. Discusión: Frente a un cuadro clínico compatible, se debe realizar estudio endos- cópico y de imágenes. El manejo quirúrgico sigue siendo el de mejores resultados, pero se han desarrollado terapias endoscópicas y combinaciones de estas con buenos resultados. Conclusión: El diagnóstico requiere un alto índice de sospecha clínica. La cirugía abierta se mantiene como el gold standard, sin embargo, en población pediátrica estaría indicada la resolución endoscópica debido a la alta morbilidad de la cirugía tradicional.
Introduction: Pyriform sinus fistula is a rare cervical branchial anomaly derived from the third and fourth branchial arch. Pyriform sinus fistula should be considered in children presenting enlarged neck mass, fistula, abscess, thyroid infection and/or dysphonia. Objective: We here report 4 cases treated in Hospital Clínico Universidad de Chile and review of the current literature on pyriform sinus fistula. Discussion: When clinical presentation is compatible with pyriform sinus fistula, endoscopic and imaging techniques are required. Surgical outcomes are better, although endoscopic therapies and combination of both surgery and endoscopy have also reported good outcomes. Conclusion: Diagnosis is made based on signs and symptoms and a high index of clinical suspicion. Open surgery is gold standard, however in pediatric population endoscopic resolution should be considered to reduce the high morbidity of traditional surgery.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Pharyngeal Diseases/surgery , Pyriform Sinus , Fistula/surgery , Pharyngeal Diseases/congenital , Pharyngeal Diseases/diagnosis , Endoscopy , Fistula/congenital , Fistula/diagnosisABSTRACT
Objective@#To investigate the feasibility and significance of modified Killian(MK) method in the clinical diagnosis of congenital pyriform sinus fistula(CPSF) by electronic laryngoscopy.@*Methods@#The following examinations were performed for 30 suspected cases of CPSF, including the traditional electronic laryngoscopy, MK examination(modified Killian position+ head rotation+ the Valsalva maneuver), barium swallow X-ray(BSX) and CT , and a prospective comparison among them were done. Patients were divided into two groups according to their age: young age group(≤14 years old) and older age group (>14 years old). The results of MK examination from the patients were analyzed and the positive diagnostic rates (PDR) between groups were compared by using χ2 tests.@*Results@#Sinuses in 20 of 30 patients were depicted from pyriform sinus in BSX, and the PDR was 66.7%(20/30). The PRD of CT was 83.3%(25/30). The presence of air bubbles around the upper lobe of the thyroid gland or at the inferomedial edge of cricothyroid joints, morphological changes of thyroid grand as well as pseudo-fistula formation on lower neck were detected clearly on CT. Comparing to the traditional electronic laryngoscopy, the effect of exposing piriform fossa fistula by MK examination is significant(χ2=17.05, P<0.05), with the PDR of 13.3%(4/30) and 76.7%(23/30) respectively. Nevertheless, comparing to BSX and CT, there were no statistically significant differences in the effect to diagnose CPSF (χ2=0.31, χ2=0.10 respectively, P>0.05). The PDR of MK in older group is significantly higher than younger group(χ2=6.68, P<0.05).@*Conclusions@#MK examination can clearly reveal the hypopharyngeal anatomical structure and detect the sinus of CPSF .It could be a safe, feasible, convenient and economical method as an application in preoperative diagnosis and follow-up examination of clinical suspected CPSF.
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Objective To investigate the image features of congenital pyriform sinus fistula (CPSF). Methods We retrospectively analyzed the clinical features and preoperative images of 80 patients with confirmed diagnosis of CPSF by surgical and pathological outcome in Guangdong general hospital from January 2007 to December 2014. At least one of the following imaging examinations were performed for all the patients, including Barium swallow X-ray (BSX), CT and MRI. Among them, 63 patients were examined with BSX, while 42 patients underwent plain and enhanced CT scans, wherein 40 of them were exanimated shortly after BSX. Thirty-two patients underwent plain and enhanced MRI scans. Patients were divided into two groups according to their age, young age group (≤14 years old) and older age group (>14 years old). Furthermore, they were also grouped based on inflammatory or quiescent stage clinically. The images of BSX, CT, and MRI from the patients were analyzed and the positive diagnostic rates (PDR) between groups were compared by using χ2 tests. Results For the patients examined with BSX, sinuses in 35 of 63 were depicted from pyriform and fistulas in 9 of 63 were depicted from the pyriform. The overall PDR of BSX was 74.6%(47/63),wherein 46.2%(12/26)in young age group , 94.6%(35/37)in older age group, 52.9%(9/17) in inflammatory stage group ,and 82.6%(38/46)in quiescent stage group. The inter-group differences were statistically significant (χ2 were 18.911 and 5.766,both P0.05).Conclusions BSX could be a screening method for suspected cases of CPSF in quiescent stage. However, the PDR could be affected by many factors (age and inflammation). CT and MRI could provide valuable information for diagnosis. An examination combined BSX and CT is preferred to improve the positive detective rate of CPSF.
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Congenital pyriform sinus fistula (CPSF) is a rare branchial abnormality,presented as acute suppurative thyroiditis, recurrent neck abscess and cellulitis.In the past, the only way to cure CPSF is surgical resect of the whole lesion in the inflammation quiescent period, which always lead to many complications and high rate of recurrence.Since late 1990s,different kinds of endoscopic procedures have beeen attempted to close the inner orifice of congenital pyriform sinus fistula.After more than 10 years,endoscopic cauterization has been recommended as the first-line treatment for its safety, effective and minimally invasive.This paper introduces and summarizes the theory, procedure, advantages and disadvantages, indications and complications of endoscopic treatment of congenital pyriform sinus fistula.
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Objective To probe the cause,clinical and imaging findings of children's congenital pyriform sinus fistula (CPSF). Methods Clinical and radiographic data in 23 patients with children’s CPSF were analyzed retrospectively which were confirmed by pathology.Results 1 6 patients represented repeated swelling and pain in left anterior neck,6 of whom were misdiagnosed as thyroid abscess and suffered surgery.7 patients represented masses in left anterior neck.Ultrasound showed all patients with diffuse en-larged thyroid gland with uneven mass and separated liquid dark space or infection in deep neck soft tissue,and no CPSF was identi-fied.The subsequent esophageal barium meal confirmed the fistula in 8 patients,and other patients underwent further CT scan with image post-processing.CT showed clear fistula in 4,suspicious fistula in 7 and no fistula in 4,All fistulas were confirmed by the pa-thology.Conclusion The combination of ultrasound,esophagogram and CT with image post-processing can improve the diagnostic sensitivity and accuracy of CPSF.
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Pyriform sinus fistula,owing to rare disease incidence and lacking of awareness,is always a puzzle to neck illness. At the mean time,The frequent delay in accurate diagnosis was reported in the literature. Pyriform sinus fistula should be considered in any children with repeated neck or thyroid infection/mass( mainly on the left side) . The combination of barium esophagography,CT scan and ultrasound is useful to establish the diagnosis. Intraoperative endoscopy-assisted intubation or methylene blue injection through the internal opening as a guide can facilitate identification of the tract during dissection,and it can effectively reduce the relapse rate.
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Acute suppurative thyroiditis is an uncommon infectious thyroid disease affecting mainly children and young adults. The route of infection is frequently a pyriform sinus fistula. The major pathogens responsible for acute bacterial suppurative thyroiditis are the Streptococcus and Staphylococcus species. In contrast, Actinomyces species are a very rare cause of acute suppurative thyroiditis. We experienced a case of a 23-year-old man who has presented general weakness and neck pain. Thyroid ultrasonography showed an ill-defined area of heterogeneous hypoechogenicity in the left lobe of the thyroid gland. Histologic examination by fine needle aspiration demonstrated gram-positive, filamentous-like organisms with branching hyphae and characteristic sulfur granules. Barium esophagogram showed a linear barium-filled track at the left pyriform sinus. We report a case of actinomycotic thyroiditis in a young adult with pyriform sinus fistula along with a brief review of related literature.
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Adult , Child , Humans , Young Adult , Actinomyces , Actinomycosis , Barium , Biopsy, Fine-Needle , Fistula , Hyphae , Neck Pain , Pyriform Sinus , Staphylococcus , Streptococcus , Sulfur , Thyroid Diseases , Thyroid Gland , Thyroiditis , Thyroiditis, Suppurative , Track and FieldABSTRACT
Acute suppurative thyroiditis is an uncommon disease of thyroid, as thyroid gland is remarkably resistant to infection. In children, the most common route of infection is from a pyriform sinus fistula and then the inflammation spreads from the sinus to the perithyroidal space. It is important to differentiate acute suppurative thyroiditis with thyrotoxicosis from subacute thyroiditis. And if left untreated, acute suppurative thyroiditis can lead to thyroid abscess formation. A 11-year-old girl presented with acute illness of fever and tender neck swelling. Thyroid ultrasonogram and ultrasono-guided needle aspirated cytology confirmed acute suppurative thyroiditis. Although on computed tomography (CT) scan suggested acute suppurative thyroiditis due to pyriform sinus fistula, there was no evidence of fistula formation between thyroid and pyriform sinus on barium esophagogram. After treatment with antibiotics, she displayed clinical improvement and was discharged without complication. Here we report a child of acute suppurative thyroiditis with transient thyrotoxicosis controlled with antibiotics with literature review.
Subject(s)
Child , Female , Humans , Abscess , Anti-Bacterial Agents , Barium , Fever , Fistula , Inflammation , Neck , Needles , Pyriform Sinus , Thyroid Gland , Thyroiditis, Subacute , Thyroiditis, Suppurative , Thyrotoxicosis , UltrasonographyABSTRACT
This is the first case report about acute suppurative thyroiditis with thyrotoxicosis and pyriform sinus in Korea. A female patient, who was previously healthy, visited our hospital for the treatment of common cold symptoms and neck pain which developed 2 weeks before the visit. The condition of the patient did not improve through the use of antipyretics and even worsened. The patient was admitted to the hospital and was diagnosed with acute suppurative thyroiditis. The culture result of the drained fluid revealed group D Streptococcus. The patients condition was improved after using antibiotics and drainage. After recovery from acute thyroiditis, esophagography was performed and the pyriform sinus was found to be obliterated by chemical cauterization. It is very important yet difficult to differentiate acute thyroiditis with thyrotoxicosis from subacute thyroiditis. In this study, we discussed the differential diagnosis between acute thyroiditis and subacute thyroiditis with a review of literature.
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Female , Humans , Anti-Bacterial Agents , Antipyretics , Cautery , Common Cold , Diagnosis, Differential , Drainage , Fistula , Korea , Neck Pain , Pyriform Sinus , Streptococcus , Thyroid Gland , Thyroiditis , Thyroiditis, Subacute , Thyroiditis, Suppurative , ThyrotoxicosisABSTRACT
Acute suppurative thyroiditis(AST) and thyroid abscess are uncommon in children. The remaining pyriform sinus tract with fistula is well known underlying abnormality of AST in pediatric patients. AST or thyroid abscess in children can be caused by infection through pyriform sinus fistulae which usually originate from the tip of the left pyriform sinus. The left-sided predominance of involvement and frequent recurrence are characteristic findings. We present a case history that include a left sided thyroid lesion of a 5-year-old girl and radiologic evidence of pyriform sinus fistula. The pus culture revealed the bacterial etiology as Staphylococcus epidermidis. Our discussion focused on the etiology and the management of AST and thyroid abscess in children.
Subject(s)
Child , Child, Preschool , Female , Humans , Abscess , Fistula , Pyriform Sinus , Recurrence , Staphylococcus epidermidis , Suppuration , Thyroid Gland , Thyroiditis, SuppurativeABSTRACT
Three patients had cervical draining sinus communicating with the pyriform sinus and one patient had acute suppurative thyroiditis resulting from infection through the pyriform sinus. There was a moderate to severe perithyroidal inflammation in all 4 cases. The age of onset ranged from 7 to 18 years old (mean; 12) but that of confirmation 9, 15, 18 and 67 years of age. Three of the patients were male and 3 of the cases involved the left side. All patients had suffered from several recurrences of cervical abscess, ranged from 2 to 7 times (mean; 4). Characteristic clinical features included 1) onset at a young age 2) frequent recurrence unless the fistula was extirpated completely 3) presenting with cervical draining sinus after repeated incision and drainage. It is supposed that the fistula is a route of infection mainly in the perithyroidal space and subsequently into the thyroid gland. When the fistula communicates directly with the thyroid gland, it can cause primary acute suppurative thyroiditis. Chronic cervical draining sinus with histories of repeated incision and drainage may be the clue to the diagnosis. A barium paste swallow study is the radiologic procedure of choice and complete removal of the fistula is the treatment of choice.