Pyriform sinus fistula is a relatively rare disease that causes recurrent neck abscess. Radical treatment for this disease involves extirpation of the fistula; however, the physical and emotional stress caused by the surgery is sometimes not well tolerated by patients, especially small children. Thus, it is important to pursue the possibility of other trearment strategies. Recently, it is suggested that chemocauterization of the internal opening of the fistula is a safe and effective mode of management of pyriform sinus fistula.
We reviewed four cases (two boys and two girls, aged 5 to 7 years) with pyriform sinus fistula treated with trichloroacetic acid (TCA) chemocauterization during the period from 2002 through 2007 at Nippon Medical School. By direct endoscopy, the opening of fistula in the left pyriform sinus was easily detected. There were no intraoperative or postoperative complications. In two of the four patients, it was not necessary to incise the neck to drain the abscess as they were managed with antibiotics and chemocauterization. Oral feeding was started within the first 2 days postoperatively. Only one of the four patients had a recurrent neck abscess, which was managed by extripation of neck granulation and repeated TCA chemocauterization.
Our experiences suggest that TCA chemocauterization is a relatively safe, simple and useful mode of treatment for pyriform sinus fistula especially in children. The appropriate concentration of TCA, indications for using this mode of treatment and the long term prognosis remain to be determined.
