Pyriform Sinus Malformation

Abstract

Pyriform sinus fistulas are considered to consist of two different types of fistulas, which originate in the third and fourth branchial clefts. Fistulas corresponding to the former type run over the superior laryngeal nerve, while those corresponding to the latter type run under the superior laryngeal nerve (SLN) [1]. In our experience, there were only two patients whose fistula seemed to originate in the third branchial cleft because the orifice of the fistula was in the upper part of the pyriform sinus. These two cases similarly showed a huge cervical cystic mass. In the majority of the patients, the fistula originated from the apex of the pyriform sinus; thus, their origin was in the fourth branchial cleft. These cases showed a relatively long fistula running downward to the thyroid gland. The recurrence rate of pyriform sinus fistula is high, especially when the fistula originates in the fourth branchial cleft. The varying clinical characteristics, method of diagnosis, and operative techniques for these two types of fistula are described.

The figures in this chapter are reprinted with permission from Standard Pediatric Operative Surgery (in Japanese), Medical View Co., Ltd., 2013, with the exception of occasional newly added figures that may appear.