Management of Pyriform Sinus Fistula with Chemocauterization

Kim, Kwang Hyun; Sung, Myung Whun; Lee, Kang Jin; Roh, Jong Lyel; Kwon, Tack Kyun; Kim, In Sang; Jin, Jung Wook

Abstract

BACKGROUND AND OBJECTIVES: A pyriform sinus fistula can cause a recurrent abscess in the neck. Complete excision is recommended but in many cases, surgery is complicated because of recurrent infection. Recurrence may result from failure to recognize, or inadequate excision of the tract. To avoid this, we attempted chemocauterization of the internal opening of the fistula tract with trichloracetic acid (TCA) on suspension laryngoscopy. MATERIALS AND METHOD: This was a 9-year review of 30 patients with pyriform sinus fistula. Medical history, diagnostic methods, operative findings and treatment results were analyzed with a review of the literatures.
RESULTS
On suspension laryngoscopy, a fistula opening was found in the pyriform sinus of all patients, mainly on the left side. Except for two patients, 28 patients were managed by TCA chemocauterization. Of the five patients who had recurrent masses, three patients were successfully managed by simple excision and two patients were managed by repeated TCA cauterization with unobliterated internal openings. There was no serious intra- or postoperative complication.
CONCLUSION
TCA cauterization is an appropriate first line treatment method for pyriform sinus fistula, especially for patients who have had recurrent neck abscess and undergone open drainage procedure. This method can be used to avoid morbidity of an open surgical procedure.