Management of a Piriform Sinus Fistula With Chronic Neck Infection in an Adult.

IF 1.3 4区 医学 Q3 OTORHINOLARYNGOLOGY
Alexandra McMillan, Stephanie Chen, Xiaoyang Hua
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Abstract

Objectives: A pyriform sinus fistula (PSF) is a rare congenital anomaly due to failed obliteration of the third or fourth pharyngeal pouch. Diagnosis and management of PSF remains controversial. We present a case of PSF and discuss its diagnosis and management.

Methods: Case report and literature review.

Results: A 26-year-old female with a chronic left lateral neck abscess was diagnosed with a left PSF. She underwent surgery through a combined approach to close the openings of the PSF, internally and externally. We first placed a blunted ET tube into the internal opening of the PSF. We then performed an external transcervical approach to close the PSF at the cricothyroid membrane. Briefly, after a neck debridement and washout of the chronic neck infection, we identified the recurrent laryngeal nerve (RLN) in Lore's triangle. We performed left hemithyroidectomy to facilitate the dissection and protection of the RLN to its entrance into the larynx. A flexible laryngoscope was then inserted into the left piriform sinus through the ET tube to guide external dissection by transillumination. The scar tissue attached to the superior pole of the left thyroid lobe was then ligated and divided along the cricothyroid membrane. Lastly, we cauterized the internal opening of the PSF. The patient has remained recurrence-free for 1.5 years with normal vocal cord mobility. Histopathology revealed presence of a squamous-lined tract adjacent to the thyroid tissue.

Conclusions: Surgical treatment for patients with PSF should be aimed at closing the internal and external openings of the PSF, debriding chronic neck infection, and protecting the laryngeal nerves, instead of removing the entire tract. A concurrent hemithyroidectomy facilitates the identification and protection of the RLN, as well as excision of the tract. Differentiation between third and fourth branchial cleft fistulae may not be clinically necessary, as it is unlikely to alter the therapeutic plan.

成人蝶窦瘘合并慢性颈部感染的治疗方法
目的:梨状窦瘘(PSF)是一种罕见的先天性畸形,是由于第三或第四咽袋闭塞失败所致。PSF 的诊断和处理仍存在争议。我们介绍了一例 PSF 病例,并讨论了其诊断和处理方法:方法:病例报告和文献综述:一名患有慢性左侧颈部脓肿的 26 岁女性被诊断为左侧 PSF。她接受了联合手术,关闭了 PSF 的内外开口。我们首先将一根变钝的 ET 管插入 PSF 内部开口。然后,我们采用经颈部外入路,在环甲膜处关闭 PSF。简而言之,在颈部清创和冲洗颈部慢性感染后,我们在洛尔三角区找到了喉返神经(RLN)。我们进行了左侧半喉切除术,以便于解剖和保护喉返神经直至其进入喉部。然后通过 ET 管将柔性喉镜插入左侧梨状窦,通过透照引导外部解剖。然后沿环甲膜结扎并分割附着在左甲状腺叶上端的瘢痕组织。最后,我们烧灼了 PSF 的内部开口。患者术后一年半没有复发,声带活动度正常。组织病理学检查显示,甲状腺组织附近存在鳞状内衬道:结论:PSF患者的手术治疗应着眼于关闭PSF的内外开口、清除颈部慢性感染和保护喉神经,而不是切除整个声带。同时进行的半喉切除术有助于识别和保护喉神经,以及切除喉道。临床上可能没有必要区分第三和第四支裂瘘,因为这不太可能改变治疗方案。
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来源期刊
CiteScore
3.10
自引率
7.10%
发文量
171
审稿时长
4-8 weeks
期刊介绍: The Annals of Otology, Rhinology & Laryngology publishes original manuscripts of clinical and research importance in otolaryngology–head and neck medicine and surgery, otology, neurotology, bronchoesophagology, laryngology, rhinology, head and neck oncology and surgery, plastic and reconstructive surgery, pediatric otolaryngology, audiology, and speech pathology. In-depth studies (supplements), papers of historical interest, and reviews of computer software and applications in otolaryngology are also published, as well as imaging, pathology, and clinicopathology studies, book reviews, and letters to the editor. AOR is the official journal of the American Broncho-Esophagological Association.
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