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. 2022 Nov 17;7(6):2145-2153.
doi: 10.1002/lio2.971. eCollection 2022 Dec.

A safe and effective surgical method for complex pyriform sinus fistula

Yun Li  1 , Huijun Yue  1 , Guoqing Lei  1 , Fanqin Wei  1 , Zhangfeng Wang  1 , Xiaolin Zhu  1 , Wenbin Lei  1
Affiliations

A safe and effective surgical method for complex pyriform sinus fistula

Yun Li et al. Laryngoscope Investig Otolaryngol. .

Abstract

Objective: This article aims to propose a new surgical method for the treatment of pyriform fistula, especially for the complex pyriform fistula.

Methods: A total of 36 patients with pyriform fistula underwent the procedure between August 2017 to October 2020. Surgery was performed by the senior authors using the same technique at the same clinical center for all patients. The median follow-up time was 33 months. Meantime, we collected information on patients with pyriform fistula using traditional surgical methods in our hospital from April 2015 to November 2018 for comparison.

Results: The surgery was successfully completed in 36 patients. In all, 32 patients had a history of multiple incisions and drainage, 16 patients had a history of surgical resections, and two patients had a history of cauterization of the internal fistula. Compared with traditional surgical methods, our new surgical method greatly shortens the length of the surgical incision (4.3 vs. 5.5, p < 0.0001), reduces the operation time (8.1 vs. 27.1, p < 0.0001), and reduces the blood loss (103.2 vs. 196.8, p < 0.0001). None of the 36 patients in this study had complications such as pharyngeal fistula, recurrent laryngeal nerve paralysis, or hypothyroidism. The mean follow-up duration after the excision of the lesion was 34.1 months. To date, no patients have relapsed.

Conclusion: Our experience showed that this surgical technique could be used to completely remove the fistula, and it was easier to perform than the conventional strategies. These treatment options result in less trauma and reliable results, especially for complex pyriform fistulas.

Level of evidence: IV.

Keywords: congenital neck mass; endoscopy; head and neck (benign); infectious/inflammatory; thyroiditis.

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Conflict of interest statement

All authors declare that there is no conflict of interest associated with this study.

Figures

FIGURE 1
FIGURE 1
Electronic laryngoscope with balloon‐blowing method. (→: fistula)
FIGURE 2
FIGURE 2
Internal pyriform sinus fistulectomy. (→: fistula). (A) Making a circular incision around the mouth of the fistula by the CO2 laser; (B) Separating along the tissue space outside the fistula and cut off it; (C) Cutting and vaporizing the residual fistula tissue by the CO2 laser; (D) Placing an absorbable gelatin sponge with staining agent in the bottom of the surgical wound; (E) Sewing by the 7‐0/8‐0 absorbable line.
FIGURE 3
FIGURE 3
External pyriform sinus fistulectomy. (T: trachea; E: esophagus; RLN: recurrent laryngeal nerve; SCM: Sternocleidomastoid muscle; CA: carotid artery; ☆: the fistula, involved thyroid lobes and corresponding scar tissue). (A and B) Dissecting the fistula along the scar and normal tissue gap; (C) Dissection the RLN and protect it; (D) Tracing the fistula along its longitudinal axis to the “blue” mark; (E) The removed fistula, involved thyroid lobes, and corresponding scar tissue; (F) Wound condition after removal of fistula.
See this image and copyright information in PMC

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