Congenital pyriform sinus fistula presenting as a neck abscess in a newborn

Teng, Yun; Huang, Shaoqiang; Chen, Guowei; Xian, Zhi-xiong; Han, Saihong; Li, Lan

doi:10.1097/md.0000000000017784

Cited by 3 publications

(6 citation statements)

References 12 publications

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“…Table I outlines the demographic and clinical features of the 21 neonates 1,6–13 . Most studies were case reports.…”

Section: Resultsmentioning

confidence: 99%

“…Table I outlines the demographic and clinical features of the 21 neonates. 1,[6][7][8][9][10][11][12][13] Most studies were case reports. Mean age at onset of symptoms was 11.6 days (AESD 11.1, range 1-18 days).…”

Section: Clinical Characteristicsmentioning

confidence: 99%

“…The various treatments utilized on the 21 reviewed neonates are displayed in Table II. During the initial endoscopic treatment, monopolar coagulation (n = 17) or laser cautery (carbon dioxide laser 1,10 [n = 2] or thallium laser 1 [n = 1]) were the most commonly used techniques. Silver nitrate coagulation was utilized in one neonate.…”

Section: Endoscopic Treatmentmentioning

confidence: 99%

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Minimally Invasive Management of Neonatal Piriform Fossa Sinus Tract: A Scoping Review

Tobia,

Cherukupalli,

Liu

et al. 2023

The Laryngoscope

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ObjectiveIn rare situations, neonates may present with respiratory distress and neck swelling from a piriform fossa sinus tract (PFST) lesion. Open surgical excision of PFST may be associated with higher complication rates, especially in neonates. Endoscopic treatment has been shown to have high success rates in older children, but neonatal outcomes appear to be less promising. The objective of this study was to review the existing literature on endoscopic treatment of PFST in neonates.Review MethodsPRISMA‐ScR guidelines for scoping reviews were employed. Medline and Embase databases were searched in accordance with a detailed search strategy. Nine studies met criteria for inclusion.ResultsA total of 21 neonates with PFST treated endoscopically were reviewed. Mean age at onset of symptoms was 11.6 days. Neck swelling was the most common presenting symptom (20/21, 95%), followed by respiratory distress (6/9, 66.6%). Success rate after initial endoscopic treatment was 57% (12/21); among those, seven patients required additional concurrent treatments such as neck/pharyngeal swelling decompression or sclerotherapy. Nine patients underwent a second intervention (43%) and three patients (14%) required three interventions. Notably, 90% of patients (19/21) achieved success with only minimally invasive approaches. Two patients underwent open salvage surgical excision after recurrence following initial endoscopic treatment.ConclusionNeonates with PFST and cystic neck masses are prone to recurrence after initial minimally invasive endoscopic treatment; however, high success rate may be achieved after repeat interventions. Adjunctive measures to optimize outcome may include swelling decompression w/wo sclerotherapy to cause fibrosis and postoperative nasogastric tube feeding.Level of EvidenceNA Laryngoscope, 2023

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“…Table I outlines the demographic and clinical features of the 21 neonates 1,6–13 . Most studies were case reports.…”

Section: Resultsmentioning

confidence: 99%

Section: Clinical Characteristicsmentioning

confidence: 99%

Section: Endoscopic Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Minimally Invasive Management of Neonatal Piriform Fossa Sinus Tract: A Scoping Review

Tobia,

Cherukupalli,

Liu

et al. 2023

The Laryngoscope

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“…8,9 Clinical presentation changes with age, 4 and in the neonate, these anomalies can rapidly lead to tracheal compression and respiratory distress. 10 Therefore, it is very important to make an accurate diagnosis as early as possible. Barium swallow x-ray may be helpful in fistula identification; however, direct laryngoscopy performed in an operating room with the exploration of the pyriform fossa plays a fundamental role in the diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Congenital Pyriform Sinus Fistula: Systematic Review and Proposal for Treatment Using a Novel Endoscopic Approach

Soloperto¹,

Fulco²,

Pera³

et al. 2022

B-ENT

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The pyriform sinus fistula (PSF) is a congenital developmental defect of the third or fourth branchial pouch. It presents as acute inflammatory swelling of the neck with recurrent deep neck abscesses, recurrent neck cystic lesions or suppurative thyroiditis. The literature reports various surgical approaches to treat this condition in children. A systematic review of the literature related to management protocols for PSF was conducted and we report a case exemplifying treatment in our department. Traditionally, treatment for PSF has been open surgery; however, in the last few decades, the minimally invasive transoral endoscopic approach has gained in importance, demonstrating long-term outcomes comparable to open surgery and with lower morbidity, and it has now become the first-choice treatment. We further describe a case of PSF treated by a transoral endoscopic approach with electric cauterization, fibrin glue obliteration of the fistula and Polydimethylsiloxane (Vox-Implants®, Bioplasty, Geleen, The Netherlands) submucosal injection. According to the authors, application of Vox-Implants® injection, in addition to standard techniques, may be helpful to reduce fistula recurrence rate after surgery.

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“…The clinical symptoms and imaging findings of CPSF in neonates differ from those in children or adults ( 11 ). However, there are quite a few empirical studies or large-scale reports on CPSF in neonates ( 9 , 12 ). The present study aimed to summarize the ultrasonography (US) and CT findings of 45 neonates with CPSF and to investigate the radiological characteristics of CPSF for early diagnosis and treatment.…”

Section: Introductionmentioning

confidence: 99%

Imaging Findings in Neonates With Congenital Pyriform Sinus Fistula: A Retrospective Study of 45 Cases

Zhao

Yao

et al. 2021

Front. Pediatr.

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Background: Congenital pyriform sinus fistula (CPSF) is a rare branchial cleft deformity. The characteristics and management of CPSF in neonates are different from those in children or adults, and a comprehensive understanding of the imaging features of neonatal CPSF can facilitate its preoperative diagnosis. Thus, the aim of this study was to summarize the ultrasonography (US) and CT imaging findings of CPSF in neonates.Methods: Forty-five full-term neonates with CPSF, confirmed by pathology after surgical resection from January 2012 to October 2020, were included in this retrospective study. All patients underwent preoperative cervical US and contrast-enhanced CT examinations, and the imaging findings were analyzed.Results: Forty-six cervical cystic masses were found in 45 neonates, including one case with bilateral lesions, three cases with lesions on the right side, and 41 cases on the left side. Both US and CT detected neck abnormality among all cases, while the diagnostic accuracy of US (15/46, 32.6%) was lower than that of CT (42/46, 91.3%). Moreover, CT showed significantly higher detection rates of intralesional air bubbles, involvement of the ipsilateral thyroid, deviation of the airway, and expansion into the mediastinal and retropharyngeal space compared with the US. As the age increased, it was more likely to present some features including the absence of air-containing, thick cyst wall, and poorly defined border (ρ <0.05).Conclusion: CPSF in the neonates showed distinctive imaging findings on contrast-enhanced CT scan, which provides important supplementary information for the diagnosis of CPSF after the initial US examination.

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Congenital pyriform sinus fistula presenting as a neck abscess in a newborn

Cited by 3 publications

References 12 publications

Minimally Invasive Management of Neonatal Piriform Fossa Sinus Tract: A Scoping Review

Minimally Invasive Management of Neonatal Piriform Fossa Sinus Tract: A Scoping Review

Congenital Pyriform Sinus Fistula: Systematic Review and Proposal for Treatment Using a Novel Endoscopic Approach

Imaging Findings in Neonates With Congenital Pyriform Sinus Fistula: A Retrospective Study of 45 Cases

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