A case of pyriform sinus fistula in neonate treated with chemical cauterization using 10% silver nitrate

Abstract

Pyriform sinus fistula is a congenital fistula arising from the pyriform sinus of the hypopharynx to the dorsal thyroid. It often presented in childhood with acute thyroiditis or neck infection.

We report a case of the patient with a 3-cm mass on the left neck at birth. Six days after birth, the patient was referred from the NICU. Cervical ultrasound scan and CT revealed a monocystic lesion on the left neck. We punctured the mass and aspirated the yellow fluid. The mass was reduced, but it grew again after feeding. Laryngoscopy revealed that fluid similar to the aspirated fluid drained from the left pyriform sinus, and we diagnosed pyriform sinus fistula. At 20 days after birth, we attempted laryngoscopy cauterization to close the fistula, but could not identify the fistula intraoperatively. We only made a cervical incision to drain the fistula. At 48 days after birth, we attempted cauterization again. We found a fistula in the left pyriform sinus of the hypopharynx and cauterized with 10% silver nitrate. Postoperatively, the cervical mass did not increase in size.

We considered 10% silver nitrate to be an effective option for fistula closure in neonatal and infantile.