Analysis Of Curative Effect Of Internal Fistula Suture In Treatment Of Piriform Fossa Fistula

ObjectivePyriform sinus fistula(PSF)is a rare condition which is due to embryological persistence or incomplete developmental anomalies.These patients usually present with repeated cervical infections and recurrences.Management options included traditional open-neck surgery,endoscopy-assisted open-neck surgery,and endoscopic obliteration of the sinus tract.Open neck surgery has widely been accepted as a definitive treatment for PSF,and endoscopic surgery has been reported in recent years However,both approaches are not satisfactory because of high recurrence rates and postoperative complications.The aim of this study was to evaluate the long-term effectiveness of the internal opening obliteration via endoscopic chemocauterization and suture as definitive treatment for pyriform sinus fistulae.MethodsA retrospective review of 75 cases of PSF treated at our department from 2012 to 2020.32 cases younger than 8 years old,43 patients older than 8 years old.Most of PSF presented as recurrent suppurative thyroiditis and neck infection mainly on the left side.All of them were treated with obliteration of the internal opening via endoscopic chemocauterization and suture.The patients presenting with acute neck abscess was performed with simultaneously neck external incision and drainage.The patients were fed through nasal feeding and performed neck debridement daily after endoscopic surgery.ResultsOf 75 patients,97.33%(73/75)of all internal opening recovered and experienced no recurrence after their first endoscopic surgery.Recurrence was developed in 2 patients in the follow-up period,they were treated with recauterization and suture 8 or 17 months after the first treatment,and then recovered.All of them treated with endoscopic surgery showed no recurrence with a follow-up period of 6-96 months.There were no complications occurred.ConclusionEndoscopic obliteration of the internal opening via chemocauterization and suture combined with simultaneously neck external incision and drainage is a safe and effective management option for pyriform sinus fistulae.Endoscopic surgery in infected state isn't a negative influence for optimal patient outcomes.We advocate using this minimally invasive technique as first line of treatment for pyriform sinus fistula.