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Source publication
Objectives
The authors present the case of a 3-year-old girl with a history of complicated surgery for removing a third branchial cleft fistula.
Methods
An endoscopic approach using N-butyl-2-acrylate and metacrilosisolfolane glue (GLUBRAN 2) to seal the fistula was performed.
Results
The clinical and radiological 6-year follow-up confirmed the a...
Citations
... Since the 1990 s, some scholars have proposed the method of internal fistula cauterization to treat patients with pyriform sinus fistula. [41][42][43][44][45] This surgical technique is simple and can be self-taught. If the conditions of CO 2 laser equipment are not available, a long electrocautery or electrocoagulation knife can be used to cauterize the internal fistula instead. ...
Objective
This article aims to propose a new surgical method for the treatment of pyriform fistula, especially for the complex pyriform fistula.
Methods
A total of 36 patients with pyriform fistula underwent the procedure between August 2017 to October 2020. Surgery was performed by the senior authors using the same technique at the same clinical center for all patients. The median follow‐up time was 33 months. Meantime, we collected information on patients with pyriform fistula using traditional surgical methods in our hospital from April 2015 to November 2018 for comparison.
Results
The surgery was successfully completed in 36 patients. In all, 32 patients had a history of multiple incisions and drainage, 16 patients had a history of surgical resections, and two patients had a history of cauterization of the internal fistula. Compared with traditional surgical methods, our new surgical method greatly shortens the length of the surgical incision (4.3 vs. 5.5, p < 0.0001), reduces the operation time (8.1 vs. 27.1, p < 0.0001), and reduces the blood loss (103.2 vs. 196.8, p < 0.0001). None of the 36 patients in this study had complications such as pharyngeal fistula, recurrent laryngeal nerve paralysis, or hypothyroidism. The mean follow‐up duration after the excision of the lesion was 34.1 months. To date, no patients have relapsed.
Conclusion
Our experience showed that this surgical technique could be used to completely remove the fistula, and it was easier to perform than the conventional strategies. These treatment options result in less trauma and reliable results, especially for complex pyriform fistulas.
Level of evidence
IV
... Management of a pyriform sinus fistula (PSF) has included an open-neck surgical procedure, laryngoscopic suture closure and endoscopic/laryngoscopic surgery with chemocauterization, electrocauterization, laser cauterization or application of surgical glue [1][2][3][4][5][6][7][8]. Regardless of the method performed, it is important to close the orifice of the PSF. ...
... Trichloroacetic acid or silver nitrate might affect the recurrent laryngeal nerve, and chemocauterization methods require repeated procedures [1]. Sealing materials, such as Glubran 2 or a combination of Tissucol and Deflux, have also been used during endoscopic surgery [5,6]. These methods are new procedures and necessitate long-term follow-up for recurrences and complications. ...
A 4-year-old girl underwent an open-neck surgical procedure for a recurrent pyriform sinus fistula (PSF). A catheter could not be inserted through the endoscope into the opening of the fistula. An open-neck surgical procedure with coring out of the fistula stained with a dye revealed that the fistula was missed near the upper lobe of the left thyroid. A guide wire was successfully inserted via the endoscope into the fistula, and the wire was gripped with forceps under fluoroscopic guidance and removed. As a modification of the surgical approach and treatment for the orifice of the PSF, a catheter was exchanged through the guide wire, and a nylon thread was passed into the catheter. The tip of the nylon thread from the oral side was fastened and fixed to a gauze ball. After removing the nylon thread, the orifice of the sinus fistula was recognized and sutured. She was discharged uneventfully and has done well without a postoperative recurrence for 12 months.
... 3,12 El manejo endoscópico ha demostrado ser una alternativa segura y efectiva con una tasa de recurrencia comparable al manejo quirúrgico abierto (el 18 % vs. el 15 %). 13 Como la morbilidad es muy baja, se pueden realizar varios intentos endoscópicos de obliteración si se da la recurrencia de síntomas. En caso de fracasos reiterados del tratamiento conservador, se recomienda la cirugía. ...
Pyriform sinus fistulas are rare anomalies of the branchial arches. The most common form of presentation in children and adolescents is acute suppurative thyroiditis and/or recurrent lateral cervical abscesses. However, fistulas can manifest atypically. The rarity of this pathology and the atypical clinical presentation can delay the diagnosis increasing the risk of recurrent infections and complications. We present the unusual case of a 13-year-old teenager with retropharyngeal abscess due to a congenital pyriform sinus fistula successfully treated by endoscopic electrocautery.
Sociedad Argentina de Pediatría.
... However, it is difficult to find the fistula in traditional open-neck surgery, or the resection is incomplete, which may lead to recurrence (1,6). In recent years, minimally invasive endoscopic occlusion of the internal opening for the treatment of PSF is performed, including biocauterization (7), electrocautery (8), chemocautery (9), coblation (10), laser cauterization (11), and suture closure (6), etc. But only a few cases are reported with high recurrence rate. ...
... Watson [17] 2013 5 2-12y 1 M 4F 1 EC 2 CO 2 Laser 2 CC with silver nitrate 100% 11-41 m 0% Parida [19] 2014 3 11-12y 1 M 2F 2 CC with silver nitrate 1 Secondary CC with silver nitrate following failed surgical excision 100% 2-3y 0% Sun [11] 2014 22 6 m-14y 7 M 15F EC 91% 1 m-14y 0% Wong [28] 2014 2 10-14y 1 M 1F 1 EC 1 Secondary EC following failed surgical excision 50% 4y 50% (mild hoarseness that resolved within 2 weeks) Hwang [24] 2015 13 1.5-15y 9 M 4F CC with 20% TCA 54% 5.5y (median) 0% Josephson [1] 2015 1 7y F CO2 laser with chromic suture 100% 4y 0% Kamide [18] 2015 1 20y F Electrocauterization 100% 1y 0% Abbas [25] 2016 1 12y F Electrocauterization 100% 22 m 0% Di Nardo [22] 2016 1 3y F Secondary Glubran 2 sealing following 4 failed surgical excisions 100% 6y 0% Huang [27] 2016 5 5-7y 3 M 2F KTP laser assisted EC with FS 80% 7-36 m 0% Matsuzaki [26] 2016 2 9-26y 1 M 1F Endoscopic partial resection with polydioxanone suture 100% 1-2y 0% Zhang [23] 2016 4211 EC 31 Coblation cauterization 88% 2-40 m 7% (temporary hoarseness) EC electrocauterization, CC Chemocauterization, FS fibrin sealent, TCA trichloroacetic acid, M male, F female, m month, y years ...
Background:
Piriform sinus fistulas occur due to developmental abnormalities of the third and fourth branchial arches, and almost always occur unilaterally. They generally present as recurrent abscesses in the anterior-inferior neck, with concurrent thyroiditis. They have conventionally been managed with complete removal of the sinus tract, and thyroidectomy if required; however, endoscopic approaches have been increasingly favored. Herein we describe a case of bilateral piriform sinus fistulas, and present a review of the literature concerning their endoscopic management.
Case presentation:
Our patient was determined to have bilateral piriform sinus fistulas based on computer tomography, magnetic resonance imaging and microlaryngoscopy. We performed electrocauterization of the proximal fistula tracts, followed by injection of fibrin sealent. Our patient has not had a recurrence in the ten months since his procedure. There were no complications. Twenty-three articles describing an endoscopic approach to these fistulas were identified through PubMed, and a search through the references of related articles was completed.
Conclusion:
Of one hundred and ninety-five patient cases we reviewed, an endoscopic procedure success rate of 82% and complication rate of 5.6% was determined. Piriform sinus fistulas that occur bilaterally are a rare congenital abnormality of the neck. Endoscopic approaches are an acceptable alternative option to open procedures, with similar success and a lower rate of complications.
... [1] There is a lack of general consensus on the management of third and fourth branchial anomalies. [2] Traditionally, surgical fistulectomy has been the treatment of choice. However, a more minimally invasive approach of cauterizing the fistula tract using a variety of methods, is gaining wider acceptance especially in younger patients and those with previous recurrences after surgery. ...
... Third and fourth branchial abnormalities are rare accounting for 2-8% and 1-4% respectively. [1,2] Classically, the origin of these fistulae is a result of persistence of the pharyngobranchial duct which connects the third and fourth pharyngeal pouches to the pharynx and normally degenerates during the 7th week of embryonic development. [3]Our patient presented with history of recurrent left sided neck abscess and discharge since childhood. ...
... Various cauterization methods include chemocauterization with trichloroacetic acid, electrocauterization with monopolar diathermy, low power diode, CO2 laser, application of silver nitrate or fibrin glue. [2,4] A systematic review conducted by Derks et al, suggested that the treatment outcomes of cauterization was comparable to surgical management. [4] In our patient we used Histoacryl (n-Butyl cyanoacrylate ), a synthetic glue that has been used for wound closure and as an embolic agent in vascular interventions. ...
Third branchial cleft anomalies are rare accounting for 2-8% of all branchial abnormalities. We report a case of a 9 year old boy who presented with discharging sinus on the left side of neck. A sinogram revealed third branchial arch fistula. The tract was surgically removed, however, on follow up the fistula was recurred. He was later taken for endoscopic cauterization and injection of Histoacryl (n-Butyl cyanoacrylate ) glue into the tract, after which his wound healed swiftly. Historically, surgical excision of the fistulous tract has been the mainstay of treatment. Recently, minimally invasive methods are gaining wider acclaim and may potentially become the treatment of choice in the future.
Management of third and fourth branchial cleft anomalies are similar. These anomalies should be suspected in a child with recurrent low-anterior neck abscess. Investigations in the form of cross-sectional studies and examination of the pharynx under anaesthesia will facilitate diagnosis and resolution of abscess. Spontaneous closure of the pyriform sinus can occur following conservative management with antibiotic treatment and abscess drainage. This emphasise the role of second-look prior to implementing endoscopic cauterisation or surgery.
