Abstract
A pyriform sinus fistula is a congenital fistula tract derived from the third, fourth, or fifth pharyngeal sac, which causes recurrent cervical infections due to bacterial invasion. Treatment includes medical therapy such as antimicrobials during the acute phase of inflammation, and, if necessary, incisional drainage. Fistulotomy through an external cervical incision is generally performed as a curative treatment. However, in recent years, there are reports of transoral cauterization of fistulas. In this study, we report three cases of pyriform sinus fistulas treated with transoral fistula cautery. Case 1 was an 18-year-old boy who presented for the treatment of recurrent cervical subcutaneous abscesses. In this case, transoral electrical cauterization was followed by chemical cauterization with 40% trichloroacetic acid. Case 2 was a 7-year-old girl who developed a cervical infection due to trauma. After medical treatment, a pyriform sinus fistula was noted, and transoral electrical cauterization and fibrin glue application were performed. Case 3 was a 46-year-old woman who presented for examination and treatment of recurrent suppurative thyroiditis. She underwent transoral electrical ablation followed by fibrin glue application. Recurrence of cervical infection was not observed in any of the cases. Transoral fistula cauterization is less invasive than external cervical incision, more cosmetically pleasing, and requires less operative time and hospitalization. There are no reports of a higher recurrence rate of cervical infections than with external cervical incision. Therefore, we recommend that transoral fistula cauterization be performed before external cervical incision.
