Right-Sided Pyriform Sinus Fistula: A Case Report and Review of the Literature

Abstract

Objectives. Pyriform sinus fistulae arise from disturbances in the development of the fetal third and fourth branchial pouches and are predominantly found on the left side. We report the rare case of a right-sided pyriform sinus fistula presenting as a lateral neck abscess. Study Design. Case report. Methods. A 24-year-old woman presented with a two-week history of right-sided neck abscess. A fluoroscopic sinogram revealed a fistulous tract extending from the abscess to the apex of the right pyriform sinus. It was determined that the fistula was likely a third or fourth branchial remnant, a rare right-sided finding. Chemocauterization of the fistulous tract with 40% trichloroacetic acid was used to successfully treat the patient. Results. Approximately 93–97% of branchial pouch anomalies are left sided. Treatment options include surgical excision and cauterization. Conclusions. Branchial cleft cyst and pyriform sinus fistula must be considered in the diagnosis of cervical abscess in either side of the neck.

Branchial cleft and pouch anomalies in childhood: a report of 50 surgical cases

“…Further, CT-fistulography could provide more detailed information about the lesion and it is helpful in surgical planning [33]. In addition, the internal opening of branchial anomalies may be demonstrated with esophagography, although this procedure is difficult during inflammation: in these cases, a direct laryngoscopy could be performed [10,31,34,38]. Even our patient with piriform sinus fistula underwent fistulography to define the course of the lesion.…”

“…Nicoucar et al [10] reported that piriform sinus anomalies presented primarily on the left side (89 %), usually as neck abscess (39 %) or acute suppurative thyroiditis (33 %); other reported presentations are: upper respiratory infections, recurrent retropharyngeal abscess and cellulitis, odynophagia, stridor and mediastinitis [31]. Interestingly, Shino et al [32] reported a case of pyriform sinus fistula infection with double tract.…”

“…Even Nicoucar et al [10] suggested that can be preferable to use endoscopic cauterization treatment in pediatric patients to reduce complications since the recurrence rates were similar with both endoscopic and open procedure. Chemocauterization with trichloroacetic acid is a less invasive procedure which may be used to obliterate the fistulous tract and can be repeated several times without making later surgery more difficult if required; however, this treatment may be prone to recurrence and in case of relapse surgery is recommended [31].…”

Thyroidal abscesses in third and fourth branchial anomalies: not only a paediatric diagnosis

“…The left‐sided preponderance of these anomalies is thought to be attributable to the asymmetric development of the fourth arch vascular structures and the involution of the ultimo branchial body on the right side. Approximately 93–97% of fourth pouch anomalies are left‐sided, although right‐sided anomalies are sporadically reported and women are slightly more prone …”

Absceso retrofaríngeo por fístula congénita del seno piriforme en una adolescente

“…L a s f í s t u l a s d e l s e n o p i r i f o r m e ( F S P ) son anomalías poco frecuentes de los arcos branquiales, producto de la obliteración incompleta de la tercera o cuarta bolsa faríngea durante la séptima semana de gestación. 1,2 Una teoría más reciente del origen de la malformación plantea que deriva del conducto timofaríngeo. 2 Más del 95 % se localizan en el lado izquierdo y se extienden desde el ápex del seno piriforme de la hipofaringe hasta la glándula tiroides o el espacio peritiroideo.…”