Use of Air Insufflation by Endoscopy to Facilitate Dissection of a Pyriform Sinus Cyst and Fistula in Neonate : A Case Report

Abstract

Pyriform sinus cyst and fistula most commonly present as recurrent deep neck infections. We describe a neonate who presented with air in the cyst and without infection, and whose fistula and cyst were resected easily by endoscopic air insufflation. A 2-day-old girl was admitted with an enlarging left-sided neck mass. She had had a full-term gestation and normal delivery, and was 2,648g in weight. On admission, there was a soft mass measuring 5×5cm on the left side of the neck. A neck magnetic resonance imaging revealed that the mass contained an air-fluid level, suggesting communication with the airway or oral cavity. A gastrografin with milk swallow (cine-esophagram) disclosed a tract extending inferiorly from the left pyriform sinus to the cyst and air in the cyst. At 19 days of age, the baby underwent surgical excision of pyriform sinus fistula and cyst after endoscopic examination detected an opening in the apex of the left pyriform sinus and an air flow through the opening into the cyst was felt palpably. The fistula tract entering into the inferior pharyngeal constrictor muscle was easily detected, and complete excision was possible at the point of the left pyriform sinus. No recurrence was noted for the next 6 months. Neonatal pyriform sinus fistulae must be differentiated from other cervical masses, and we should try to discover the fistulae as soon as possible and resect them before infection sets in. Air insufflation is useful for the diagnosis and therapy of a pyriform sinus cyst and fistula in neonate.