2025 Volume 61 Issue 2 Pages 329-334
Neonatal cervical cysts are rare but significant clinical findings. This case report discusses a 15-day-old girl with a left cervical cyst, highlighting the diagnostic challenges and surgical management of neonatal pyriform sinus cyst. On day 5 after birth, the patient presented with left cervical swelling and wheezing. Initial imaging revealed a left cervical cyst displacing the trachea with significant inflammation. Incision and drainage were performed, and the patient was referred with suspected cervical lymphangioma. Subsequent CT scans indicated air in the cyst, suggesting a pharyngeal cleft remnant. Despite inconclusive ultrasonography, CT angiography, barium swallow test, and cyst puncture contrast study, a pyriform sinus fistula was highly suspected. Following inflammation subsidence, surgery was performed on day 29. Preoperative endoscopy confirmed a left pyriform sinus fistula. The cyst was excised, and a guidewire was used to ensure complete fistula removal. This case underscores the increasing incidence of congenital pyriform sinus fistula in neonates. Accurate diagnosis and complete surgical excision are crucial for effective management. This report, along with a review of 48 cases in Japan, emphasizes the importance of precise fistula localization and appropriate surgical techniques.
