The Anatomic Characteristics And Surgical Treatment Of Congenital Pyriform Sinus Fistula

Objective:To discuss the clinical anatomic characteristics of congenital pyriform sinus fistula and summarize the experience of open neck surgery.Methods: Clinical data of 12 patients with congenital piriform fossa fistula diagnosed by surgery and pathology admitted to our hospital from October 2012 to February 2018 were retrospectively analyzed.8 males and 4 females were aged from6 to 38 years,with an average age of 17.2 years.The age of initial symptom was 1?27years,and the average age was 9.4 years.All lesions were located at the left side,including 7 sinus and 5 fistula.3 patien tspresented acute suppurative thyroiditis,4neck abscesses.Combined with relevant literature and intraoperative findings,clinical characteristics,anatomical characteristics and surgical methods of congenital piriform fossa fistula were discussed and summarized.Results:All patients underwent left piriform fossa fistula resection + left superior thyroidectomy + laryngeal recurrent nerve anatomy.During the operation,all lesions were located below of superior laryngeal nerve.All fistulas are closely related with the supperior part of thyroid gland and laterally passed over the left recurrent laryngeal nerve just before merging into the apex of piriform sinus or beginning of aesophagus.All the 12 patients completed the operation successfully and recovered successfully.Follow-up periods ranging between 8 to 65 months.Two months after surgery,one patient showed lateral neck abscess again.After open drainage procedures and antibiotics treatment,there was no recurrence signs during 3 years of follow-up.Conclusion: There are some new findings about congenital pyriform sinus fistula are closely related to the superior thyroid gland and recurrent laryngeal nerve,which are different from the popular theory.We have not encountered types descending into mediastinum and thoracic cavity or ascending along common carotid artery sheath.All fistulas passed over the left recurrent laryngeal nerve,and then merging into the apex of pyriform sinus or beginning of aesophagus.The key point forsuccessful resection of fistulas in block is to remove the superior involvement part of the thyroid gland and exposure the recurrent laryngeal nerve.Based on our practical findings,the neck dissection procedure shouldn't be taken in some patients that the anatomical structure is not clear for repeated infections.