Piriform Sinus Tracts in Children

Abstract

Objectives: To describe the various presentations and management of piriform sinus tracts in children.Methods: The case records of 7 children with piriform sinus tracts who presented to the pediatric otolaryngology service were reviewed. Data on their symptoms at presentation, investigations, therapeutic interventions, and follow-up were recorded.Results: Four different modes of presentation were identified. Two presented primarily with an intrathyroidal abscess, 2 with recurrent deep neck infections requiring repeated drainage, 2 with draining fistulas to the exterior, and 1 with hoarseness. Barium swallows identified the tracts in 4 of 7 patients. Telescopic hypopharyngoscopy identified the tracts in all 7. Five were managed with complete excision of their tracts, 1 with internal cautery of the opening, and 1 with observation. All 7 are currently asymptomatic.Conclusions: Piriform sinus tracts are rare. Most present with suppurative thyroiditis. Telescopic hypopharyngoscopy is the diagnostic modality of choice. Complete excision is curative. Internal cautery may be used in compliant patients with regular follow-up. The role of observation alone remains unknown.

Endoscopic chemical cautery of piriform sinus tracts: A safe new technique

“…Literature suggests that some of them can remain asymptomatic for many years, often leading to misdiagnosis at initial presentation. Previous studies from our institution have emphasized the need for direct visualization of the internal opening of the tract to confirm the diagnosis [1,4]. Barium swallows are part of the diagnostic work up but are unlikely to show the tract until the acute event has subsided.…”

“…# 2007 Elsevier Ireland Ltd. All rights reserved. these anomalies can lie dormant for many years before presentation and hence absence of symptoms cannot definitely rule out patency of the tract [1,4]. We present our initial experience with endoscopic chemical cautery of two piriform sinus tracts along with direct and radiologic confirmation of closure of one of them.…”

“…Most literature suggests that they are remnants of the third and fourth branchial pouches [1][2][3]. These tracts are generally left sided and tend to present with suppurative thyroiditis.…”

“…Although the presentation and methods of investigating piriform sinus tracts have been well described and agreed upon, their treatment remains controversial. The recent recognition of the fact that some of them could be asymptomatic makes it even harder to make strong recommendations regarding surgical therapy [1]. Complete surgical excision, endoscopic cautery and observation have all been recommended depending on the clinical presentation [1,2,4].…”

Management of congenital fourth branchial arch anomalies: a review and analysis of published cases

“…Seven patients (1%) were waiting for treatment at the time of the report. Looking at individual age categories among the 518 patients where age was reported, and tabulating all treatments administered, rather than just initial treatments, we found that 14 Looking again at the overall group, the failure rate after initial incision with drainage was 221 (89%). Repeated attempts at incision and drainage were performed in 132 (60%) of initially failed cases; in 14 (6%), no further treatment was reported despite recurrences.…”