Retrospective case review of pyriform sinus fistulae of third branchial arch origin commonly presenting as acute suppurative thyroiditis in children

2012 ◽  
Vol 126 (7) ◽  
pp. 737-742 ◽  
Author(s):  
D Yolmo ◽  
J Madana ◽  
R Kalaiarasi ◽  
S Gopalakrishnan ◽  
M Kiruba Shankar ◽  
...  
Keyword(s):  
Fistulous Tract ◽  
Branchial Arch ◽  
Pyriform Sinus ◽  
Barium Swallow ◽  
Case Review ◽  
Retrospective Case ◽  
Suppurative Thyroiditis ◽  
Ultrasound Computed Tomography ◽  
Acute Suppurative Thyroiditis ◽  
Operative Ultrasound

AbstractObjective:Abnormalities of the third branchial arch are less common than those of the second arch and usually present with left thyroid lobe inflammation. This paper describes 15 cases of pyriform sinus fistulae of third branchial arch origin usually presenting as recurrent thyroid abscess on the left side.Method:A retrospective review of 15 cases of third arch fistulae managed 2000 and 2008, diagnosed based on histopathology and radiological evidence of a fistulous tract, and treated with fistulectomy with left hemithyroidectomy.Results:All patients (six boys and nine girls, aged three to 15 years) presented with recurrent low neck inflammation. Pre-operative ultrasound, computed tomography fistulography and barium swallow demonstrated a third arch fistulous tract, left-sided in all cases. The fistula was detected intra-operatively and pathologically in all cases. Surgery (successful in all cases) emphasised complete recurrent laryngeal nerve and ipsilateral pyriform sinus exposure, to facilitate tract excision, with left hemithyroidectomy. There was no recurrence over three to five years' follow up.Conclusion:Paediatric recurrent low neck inflammatory episodes, due to thyroidal abscess, especially left-sided, should raise suspicion of pyriform sinus fistulae.

scholarly journals Outcomes of endoscopic chemo- and laser-cauterizations and open fistulectomy for pyriform sinus fistula

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
Hiroo Masuoka ◽  
Akira Miyauchi ◽  
Takahiro Sasaki ◽  
Tsutomu Sano ◽  
Akihiro Miya
Keyword(s):  
Mouth Opening ◽  
Pyriform Sinus ◽  
Barium Swallow ◽  
Success Rates ◽  
Suppurative Thyroiditis ◽  
Endoscopic Procedures ◽  
Pyriform Sinus Fistula ◽  
Lower Blood ◽  
Acute Suppurative Thyroiditis ◽  
The Individual

Abstract Background Acute suppurative thyroiditis through the congenital pyriform sinus fistula (PSF) often recurs if the fistula is not resected. Although endoscopic chemo-cauterization (ECC) to obliterate the orifice of the fistula is less invasive than open fistulectomy, it may require repeated treatments. We recently adopted an endoscopic diode laser-cauterization (ELC) system with the intention of improving treatment outcomes in PSF. Here, we describe ELC and compare the outcomes of these three modalities. Methods We evaluated 83 patients with PSF who underwent treatment between 2007 and 2018 at Kuma Hospital, a tertiary thyroid treatment hospital. ECC and ELC were implemented in 2007 and 2015, respectively. Patients who were ineligible for the endoscopic procedures underwent open fistulectomy. Barium swallow studies and computed tomography scan under a trumpet maneuver were performed after treatment to evaluate obliteration or removal of the fistula. Results In total, 70 of the 81 (86%) patients who underwent barium swallow studies after the first treatment achieved obliteration or removal of the fistula. The success rates for open fistulectomy, ECC, and ELC were 100% (9/9), 83% (49/59), and 100% (13/13), respectively. ECC and ELC had significantly shorter operative times and lower blood loss than open fistulectomy. Insufficient opening of the mouth was the major reason for converting endoscopic procedures to open fistulectomy. Conclusions ELC may yield superior outcomes and is therefore the optimal treatment modality for PSF. However, it is still associated with certain limitations. Thus, treatment selection remains dependent on the shape and size of the PSF and the mouth opening of the individual patient.

Pyriform Sinus Fistula: An Unusual Cause of Recurrent Retropharyngeal Abscess and Cellulitis

1986 ◽  
Vol 95 (4) ◽  
pp. 377-382 ◽  
Author(s):  
Howard L. DeLozier ◽  
Robert A. Sofferman
Keyword(s):  
Thyroid Gland ◽  
Surgical Approach ◽  
Pyriform Sinus ◽  
Retropharyngeal Abscess ◽  
Barium Swallow ◽  
Suppurative Thyroiditis ◽  
Common Cause ◽  
Surgical Exploration ◽  
Swallow Study ◽  
Congenital Fistula

Recurrent retropharyngeal cellulitis and recurrent suppurative thyroiditis are rare entities that share a common cause. A congenital fistula from the pyriform sinus apex to the thyroid gland has been identified in approximately 23 cases of suppurative thyroiditis and now has been implicated in a case of retropharyngeal abscess and repeated episodes of cellulitis. Virtually all reported cases have been on the left side, and the fistula is usually identified with a barium swallow study. When the esophagogram fails to demonstrate a fistula, a careful endoscopic search in the area of the left pyriform sinus should be actively pursued. An external surgical approach, which includes resection of the entire tract and involved area of the left thyroid, has been curative in all reported cases subjected to definitive surgical exploration.

scholarly journals Complete Pyriform Sinus Fistulas: Case Series and Review of Literature

2011 ◽  
Vol 2 (3) ◽  
pp. 134-137
Author(s):  
Sandeep Bansal ◽  
Abhishek Jaswal
Keyword(s):  
Case Series ◽  
Pyriform Sinus ◽  
Suppurative Thyroiditis ◽  
Upper Respiratory Infection ◽  
Pyriform Sinus Fistula ◽  
Fourth Arch ◽  
Acute Suppurative Thyroiditis ◽  
Neonates And Infants ◽  
Painful Neck ◽  
Branchial Anomalies

ABSTRACT Pyriform sinus fistula belongs to the rarest group of cervical fistulae accounting for 3 to 10% of all branchial anomalies.1 The first clinical and embryological studies were described in the early seventies by Sandborn and Tucker, but embryological knowledge in this field remains incomplete. Children and adults usually complaint of painful neck swelling accompanied by fever that is preceded by upper respiratory infection, otalgia and odynophagia. Neonates and infants may have respiratory distress, sometimes with stridor, due to tracheal compression by the abscess.1,5,6 However, the most common mode of presentation is the recurrent episodes of acute thyroiditis. Eighty percent of patients with recurrent acute suppurative thyroiditis due to persistent pyriform sinus fistula present during the first decade of life. Making the distinction between third and fourth arch fistulas is difficult on clinical grounds alone and hence they are often collectively termed pyriform sinus fistula. Owing to the rarity of the condition and varied clinical presentation, diagnosis and ultimate management is often delayed leading to undue morbidity to the patient and professional frustration for the treating surgeon. We, hereby, present a case series of three classical cases of complete pyriform sinus fistulas with review of available literature in an attempt to clarify issues regarding presentation, diagnosis and management of this condition.

Recurrent cervical abscess due to piriform sinus fistula

1995 ◽  
Vol 109 (9) ◽  
pp. 886-888 ◽  
Author(s):  
Hiroshi Yamashita ◽  
Takaaki Noguchi ◽  
Masahiro Takahashi
Keyword(s):  
Barium Swallow ◽  
Anterior Neck ◽  
Suppurative Thyroiditis ◽  
Piriform Sinus ◽  
Acute Suppurative Thyroiditis ◽  
Piriform Sinus Fistula

AbstractA case of recurrent abscess on the left anterior neck due to a left piriform sinus fistula is presented. It is known that a piriform sinus fistula may cause acute suppurative thyroiditis, and also that it induces the recurrent anterior cervical abscess described in this case. Here, we suggest that barium swallow is an important aid to diagnosis cases of recurrent cervical abscess.

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