Journal article
Management of a Piriform Sinus Fistula With Chronic Neck Infection in an Adult
Annals of otology, rhinology & laryngology, Vol.133(12), pp.1029-1032
12/2024
DOI: 10.1177/00034894241280693
PMID: 39302013
Abstract
Objectives: A pyriform sinus fistula (PSF) is a rare congenital anomaly due to failed obliteration of the third or fourth pharyngeal pouch. Diagnosis and management of PSF remains controversial. We present a case of PSF and discuss its diagnosis and management. Methods: Case report and literature review. Results: A 26-year-old female with a chronic left lateral neck abscess was diagnosed with a left PSF. She underwent surgery through a combined approach to close the openings of the PSF, internally and externally. We first placed a blunted ET tube into the internal opening of the PSF. We then performed an external transcervical approach to close the PSF at the cricothyroid membrane. Briefly, after a neck debridement and washout of the chronic neck infection, we identified the recurrent laryngeal nerve (RLN) in Lore’s triangle. We performed left hemithyroidectomy to facilitate the dissection and protection of the RLN to its entrance into the larynx. A flexible laryngoscope was then inserted into the left piriform sinus through the ET tube to guide external dissection by transillumination. The scar tissue attached to the superior pole of the left thyroid lobe was then ligated and divided along the cricothyroid membrane. Lastly, we cauterized the internal opening of the PSF. The patient has remained recurrence-free for 1.5 years with normal vocal cord mobility. Histopathology revealed presence of a squamous-lined tract adjacent to the thyroid tissue. Conclusions: Surgical treatment for patients with PSF should be aimed at closing the internal and external openings of the PSF, debriding chronic neck infection, and protecting the laryngeal nerves, instead of removing the entire tract. A concurrent hemithyroidectomy facilitates the identification and protection of the RLN, as well as excision of the tract. Differentiation between third and fourth branchial cleft fistulae may not be clinically necessary, as it is unlikely to alter the therapeutic plan.
Details
- Title: Subtitle
- Management of a Piriform Sinus Fistula With Chronic Neck Infection in an Adult
- Creators
- Alexandra McMillan - Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, IA, USAStephanie Chen - University of IowaXiaoyang Hua - University of Iowa Hospitals and Clinics
- Resource Type
- Journal article
- Publication Details
- Annals of otology, rhinology & laryngology, Vol.133(12), pp.1029-1032
- Publisher
- SAGE PUBLICATIONS INC
- DOI
- 10.1177/00034894241280693
- PMID
- 39302013
- ISSN
- 0003-4894
- eISSN
- 1943-572X
- Grant note
- NIH: 1R01HL167271- 01A1, N5KL2TR002536-04 Jumpstarting Tomorrow Seed Grant: R21 AI096139-01A1
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by funding from NIH grants 1R01HL167271- 01A1 (XH), N5KL2TR002536-04 (XH), Jumpstarting Tomorrow Seed Grant (XH), R21 AI096139-01A1 (XH), and University of Iowa Carver Trust Pilot Grant (XH). There is no other financial support to disclose.
- Language
- English
- Electronic publication date
- 09/20/2024
- Date published
- 12/2024
- Academic Unit
- Pathology
- Record Identifier
- 9984719237902771
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