International Journal of Head and Neck Surgery

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VOLUME 2 , ISSUE 3 ( September-December, 2011 ) > List of Articles


Complete Pyriform Sinus Fistulas: Case Series and Review of Literature

Abhishek Jaswal

Citation Information : Jaswal A. Complete Pyriform Sinus Fistulas: Case Series and Review of Literature. Int J Head Neck Surg 2011; 2 (3):134-137.

DOI: 10.5005/jp-journals-10001-1068

Published Online: 01-12-2012

Copyright Statement:  Copyright © 2011; The Author(s).


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.

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  1. Fourth branchial arch sinus: Clinical presentation, diagnostic workup, and surgical treatment. Laryngoscope 1999;109:442-46.
  2. A branchial cleft cyst of fourth pouch origin. J Pediatr Surg 1972;7:82.
  3. Fourth branchial cleft (pharyngeal pouch) remnant. Trans Am Acata Ophthalmol Otolaryngol 1973;77:368-71.
  4. Fourth branchial fistula. Otolaryngol Head Neck Surg 1981;89:520-22.
  5. Pediatric neck masses: Guidelines for evaluation. Int J Pediatr Otorhinolaryngol 1988;16(3):199-210.
  6. Branchial anomalies: A review of 52 cases. Laryngoscope 1995;105(9 Pt 1):909-13.
  7. Recurrent acute suppurative thyroiditis in an adult due to a fourth branchial pouch fistula. The Journal of Clinical Endocrinology and Metabolism 2000;85(3):953-56.
  8. Recurrent suppurative thyroiditis due to fourth branchial pouch sinus. Int J Pediatr Otolaryngol 1985;9:89-96.
  9. Before we are born. Essentials of embryology and birth defects (5th ed). Philadelphia, PA: Saunders 1998;197-211.
  10. Occult congenital pyriform sinus fistula causing recurrent left lower neck abscess. Head Neck 1999;21:671-76.
  11. Fourth branchial pouch anomalies: A study of six cases and review of the literature. Int J Pediatr. Otorhinolaryngol 1998;44(1):5-10.
  12. Fourth branchial pouch sinus: Diagnosis and treatment. Otolaryngol Head Neck Surg 1991;105(1):44-50.
  13. Head and neck anomalies related to the branchial apparatus. Otolaryngol Clin North Am 2000;33(6):1309-32.
  14. Ten years of experience with third and fourth branchial remnants. J Pediatr Surg 2000;37(5):685-90.
  15. The endoscopic and surgical management of pyriform sinus fistulae in infants and children. J Pediatr Surg 1986;21:398-401.
  16. Case report: Fourth branchial pouch sinus. Ear Nose Throat J 1993;72:356-58.
  17. Pouches of the pharynx and esophagus with special reference to the embryological and morphological aspects. Br J Surg 1933;21:235-56.
  18. Internal fistula as a route of infection in acute suppurative thyroiditis. Lancet 1979;1:751-52.
  19. Pyriform sinus fistula. Arch Surg 1981;116:66-69.
  20. Surgical approach to pyriform sinus fistula. Am J Otolaryngol 1993; 14:111-15.
  21. Acute suppurative thyroiditis in an asymptomatic woman: An atypical presentation simulating thyroid carcinoma. Clin Endocrinol 1994;40:145-50.
  22. Distribution of C cells in the thyroid gland with pyriform sinus fistula. Otolaryngol Head Neck Surg 1995;112:268-73.
  23. Branchial pouch sinus tract from piriform fossa causing acute suppurative thyroiditis, neck abscess, or both: CT appearance and the use of air as a contrast agent. Am J Radiol 1996;167:1569-72.
  24. The diagnosis and management of pyriform sinus fistulae in infants and young children. J Pediatr Surg 1983;18:377-81.
  25. Acute suppurative thyroiditis. Am J Dis Child 1979;133:757.
  26. Recurrent acute suppurative thyroiditis. J Otolaryngol 1991;20:126-29.
  27. Recurrent left cervical abscess secondary to persistent pyriform sinus fistula. JR Coll Surg Edinb. 1998;43:125-26.
  28. Persistent third branchial apparatus. J Pediatr Surg 1991;26(6):663-65.
  29. Neck infection associated with pyriform sinus fistula: Imaging findings. Am J Neuroradiol 2000;21(5):817-22.
  30. Endoscopic cauterization for treatment of fourth branchial cleft sinuses. Arch Otolaryngol Head Neck Surg 1998;124:1021-24.
  31. Fourth branchial pouch sinus with recurrent deep cervical abscesses successfully treated with trichloroacetic acid cauterization. Acta Otolaryngol 2003;123:879-82.
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