ABSTRACT
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.
ABSTRACT
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.