Diagnosis And Treatment Of Congenital Pyriform Sinus Fistula In Children

Objective:The Congenital Pyriform Sinus Fistula(CPSF)is a rare congenital disease with complex anatomical structure,and the clinical manifestation of the children is not the same,of whom the recurrence rate,leakage rate and misdiagnosis rate are high.In this study,in order to choose the best option of treatment,the clinical data of 31 cases with well-diagnosed CPSF were analyzed retrospectively,with the characteristics of CPSF being further studied,the common problems in diagnosis and treatment being studied,and the diagnosis and operation methods of CPSF being discussed.Methods:The clinical data of 31 cases of CPSF children were analyzed retrospectively from January 2013 to November 2017 in Ear,Nose,Throat,Head and Neck Surgery in Kunming Children Hospital.The age range was 11 months old to 14 years old,and the median age was 5 years old.Most of the children were misdiagnosed and most had multiple incisions and drainage.The clinical symptoms include recurrent infection of the neck,the formation of inflammatory masses and/or Neck abscess(Na)near the thyroid region.Pre-operative Imaging examination consisted of ultrasonography of the neck,Barium Swallow(BSX),Computed Tomography(CT)and Magnetic Resonance Imagin(MRI)were used to observe the results of children with CPSF,with the result of the positive rate of the different image results.The children in the period of inflammation were exposed to puncture or cut open drainage to make drug-sensitive drugs,and antibiotics were used according to the results.In the period of Phlebitis,the shape of the Piriform Fossa was examined by laryngoscope before operation,and insert ureter 8 into the ureter to inject a methyl blue tracer Fistula after the process of the Internal Fistula is confirmed,and the operation was performed by high ligation of the external diameter of the neck.Results:The study found that the positive rate of MRI was 88.46%(23/26),the positive rate of CT examination was 87.10%(27/31),the positive rate of BSX examination was 77.78%(21/27)and the positive rate of ultrasonography was 70.97%(22/31).Ultrasonography and CT examination,ultrasonography and MRI were all statistically significant(χ2 were 2.43,2.60,p<0.05).The cervical BSX test combined with MRI was better than other joint examinations,and the positive rate of diagnosis of CPSF was 100%.Thirty cases were unilateral,with 1 bilateral disease,27 cases on the left side,3 cases on the right side.The morphology of the internal Fistula was different right under the laryngoscope,with 3 cases needle-shaped,6 round,and 9 oval,and the fistula mucosal swelling and abscess discharge were observed in 13 cases.The children were injected with methylene blue at the fistula incision under the laryngoscope,a fistula resection by external carotid approach for 5 days,and anti-infection and enhanced nutritional treatment.There was no hoarseness and no cough in the children after operation.In one patient,the incision infection occurred within 1 week after operation,with the pharyngeal fistula considered,the local change enhanced and the recovery was good.After operation,the children were followed up for 6 months to 3 years,with median follow-up for 12 months,and all recovered well with no recurrence.Conclusion:If cervical inflammation or application of antibiotics is found to be unsatisfactory in clinical work,children with repeated neck infections.In particular,the possibility of CPSF should be suspected when infection occurs in the left side of the neck.Imaging examination,neck b-ultrasonography,BSX,CT and MRI will be helpful for diagnosis,especially with BSX and MRI.After diagnosis,various treatment methods have their own advantages and disadvantages.Through the comprehensive comparison,traditional surgical treatment is still the preferred treatment for CPSF,and the intraoperative radial fistula injection of methylene blue can completely remove the lesion,and avoid relapses and complications.