Misdiagnosed pyriform sinus fistula revealed by iterative neck abscesses: A case report and review of the literature

Abstract

The pyriform sinus fistula is a rare condition described as an epithelialized tract connecting the skin of the neck to the foregut, and may result in cervical cysts and iterative abscesses misleading the diagnosis. The clinical and radiological examinations are all useful. Surgery stands as one of the most effective therapeutic options consisting on the total excision on the eventual cyst, and the fistula that is followed to its inner opening on the pyriform sinus. We present a case of a 3-years-old boy with a pyriform sinus fistula that caused recurrent neck abscesses treated independently delaying the diagnosis. Once in our structure, after radiological examination and antibiotics to cool the infection down, the surgery removed the cyst with its tract that opened in the pyriform sinus. The follow up showed an effective result with the total disappearance of the lesion with no more infectious episodes. Even if it's a rare condition, the diagnosis of apyriform sinus fistula must be considered in front of every patient with a history of recurrentlatero cervical abscess.

Isolated oropharyngeal abscess with hypopharyngeal extension recurring 12 years after initial surgical management: A case report and review of the literature

“… 45 Established treatments are only available for recurrent abscesses that arise from congenital anomalies, such as branchial cleft anomalies 7 – 9 and pyriform sinus fistulas. 10 , 11 For these cases, surgical management of the underlying congenital anomaly successfully prevents further abscess recurrence. Furthermore, while tonsillectomy might seem like a reasonable approach to mitigate recurrence, evidence suggests that adult patients having received the surgery are at a higher risk of pharyngeal infections.…”

“…A total of seven studies were included in the qualitative synthesis. [5][6][7][8][9][10][11] The studies were published from 1997 to 2020. The studies were published from 1997 to 2020.…”

A Rare Case of Pyriform Sinus Fistula in an Adult

“…It results from the persistence of the pharyngobranchial duct that connects the third and fourth pharyngeal pouches. Normally, the pyriform sinus degenerates in the seventh week of embryonic development [2]. Pyriform sinus fistula presents as latero-cervical swelling, especially on the left side, dysphagia, sore throat, hoarseness, and upper respiratory infection [5].…”

“…This is a rare congenital condition due to disturbances in the development of the fetal branchial apparatus, specifically, failure to obliterate the third and fourth pharyngeal pouches. Interestingly an external opening to the skin is rarely present [2]. The pyriform sinus fistula is prone to recurrent deep neck space infection and abscess formation [3].…”