Recurrent neck lesions secondary to pyriform sinus fistula

详细信息    查看全文

• 作者：Peijun Zhang ; Xiufen Tian
• 关键词：Recurrent neck lesions ; Pyriform sinus fistula ; Diagnosis ; Surgery management ; Endoscopic treatment
• 刊名：European Archives of Oto-Rhino-Laryngology
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：273
• 期：3
• 页码：735-739
• 全文大小：524 KB
• 参考文献：1.Mukerji SS, Parmar H, Ibrahim M, Bradford C (2007) An unusual cause of recurrent pediatric neck abscess: pyriform sinus fistula. Clin Imaging 31(5):349–351CrossRef PubMed
  2.Madana J, Yolmo D, Gopalakrishnan S, Saxena SK (2010) Complete congenital third branchial fistula with left-sided, recurrent, suppurative thyroiditis. J Laryngol Otol 124(9):1025–1029CrossRef PubMed
  3.Liberman M, Kay S, Emil S et al (2002) Ten years of experience with third and fourth branchial remnants. J Pediatr Surg 37(5):685–690CrossRef PubMed
  4.Cespedes C, Duran P, Uribe C et al (2013) Thyroid abscess. A case series and literature review. Endocrinol Nutr 60(4):190–196CrossRef PubMed
  5.Madana J, Yolmo D, Saxena SK, Gopalakrishnan S (2010) Thyroid abscess with branchial anomaly. Int J Pediatr Otorhinolaryngol Extra 5(4):170–173CrossRef
  6.Madana J, Yolmo D, Kalaiarasi R et al (2011) Recurrent neck infection with branchial arch fistula in children. Int J Pediatr Otorhinolaryngol 75(9):1181–1185CrossRef PubMed
  7.Nicoucar K, Giger R, Pope HG Jr et al (2009) Management of congenital fourth branchial arch anomalies: a review and analysis of published cases. J Pediatr Surg 44(7):1432–1439CrossRef PubMed
  
• 作者单位：Peijun Zhang (1)
  Xiufen Tian (1)
  
  1. Department of Otorhinolaryngology and Head-Neck Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Otorhinolaryngology
  Neurosurgery
  Head and Neck Surgery
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1434-4726

文摘

Recurrent neck lesions associated with third or fourth branchial arch fistula are much less common than those of second arch and usually present with acute suppurative thyroiditis or neck abscess. Our aim is to describe clinical features, management and treatment outcomes of 64 cases of congenital pyriform sinus fistula (PSF). Medical record of these 64 patients (33 males, 31 females) treated at the First Affiliated Hospital of Zhengzhou University from 2011 to 2014 were reviewed. The patients comprised 33 males and 31 females, and their ages ranged from 18 months to 47 years (median 10 years, mean 12.7 years). Neck abscess and recurrent infection was the mode of presentation in 37 cases (57.8 %), 4 patients (6.3 %) presented with acute suppurative thyroiditis, neck mass was the mode of presentation in 17 cases (26.6 %), 2 patients (3.1 %) presented with neck mass with respiratory distress, and cutaneous discharging fistula was the mode of presentation in 1 cases (1.6 %). The remaining 3 patients (4.7 %) presented with cutaneous discharging fistula with neck infection. Investigations performed include barium swallow, CT scan, and ultrasound which were useful in delineating PSF tract preoperatively. Barium swallow was taken as the gold standard for diagnosis. Our patients were treated by fistulectomy with hemithyroidectomy, fistulectomy, fistulectomy with endoscopic electric cauterization, endoscopic electric cauterization or endoscopic coblation cauterization, respectively. Histopathologic examination of the surgical specimens revealed that they were lined with ciliated epithelium, stratified cuboid epithelium with chronic inflammatory cell infiltration and fibrosis. Voice hoarseness occurred after operation in seven patients, but disappeared 1 week later. PSF recurred in 6 patients, 4 of them were cured by a successful re-excision. One patient was cured by successful endoscopic electric cauterization. The other 1 has remained asymptomatic for 5 months. In our series, mean follow-up period was 13.3 months and median follow-up period was 12.5 months (range 2–40 months). Presence of congenital PSF should be suspected when intra-thyroidal abscess formation occurs as the gland is resistant to infection. Strong clinical suspicion, barium swallow study, CT scan and ultrasound are the key to diagnosis. Both fistulectomy with hemithyroidectomy and endoscopic treatment have comparable success rate. Endoscopic coblation cauterization may prove a useful and equally effective method of treatment for PSF in future.