Kevin D Pereira1, Jennifer N Davies. 1. Department of Otolaryngology-Head and Neck Surgery, The University of Texas Medical School at Houston 77030, USA. Kevin.D.Pereira@uth.tmc.edu
Abstract
OBJECTIVES: To describe the various presentations and management of piriform sinus tracts in children and to provide a treatment algorithm. DESIGN: Case series. SETTING: Pediatric otolaryngology service in a tertiary care setting. PATIENTS: Eight pediatric patients diagnosed as having a piriform sinus tract between 1999 and 2005. INTERVENTIONS: Patients were treated with surgical excision, endoscopic cauterization, or observation. MAIN OUTCOME MEASURE: Recurrence of neck infection. RESULTS: Three different modes of presentation were identified. Four patients presented primarily with an intrathyroidal abscess; 2 presented with recurrent deep neck infections requiring repeated drainage; and 2 presented with symptoms unrelated to the tract. Barium swallows identified the tracts in 5 of 8 patients, and telescopic hypopharyngoscopy identified the tracts in all 8 patients. Five patients were treated with complete excision of their tracts; 1 was treated with cauterization of the internal opening; and 2 were observed for symptoms related to the tracts. All 8 patients are currently asymptomatic. CONCLUSIONS: Piriform sinus tracts are rare. Most patients with tracts present with recurrent deep neck infections. Telescopic hypopharyngoscopy is the diagnostic modality of choice. Endoscopic cauterization is recommended as the initial therapy in symptomatic patients, with complete excision reserved for recurrences. Observation is appropriate for asymptomatic patients.
OBJECTIVES: To describe the various presentations and management of piriform sinus tracts in children and to provide a treatment algorithm. DESIGN: Case series. SETTING: Pediatric otolaryngology service in a tertiary care setting. PATIENTS: Eight pediatric patients diagnosed as having a piriform sinus tract between 1999 and 2005. INTERVENTIONS:Patients were treated with surgical excision, endoscopic cauterization, or observation. MAIN OUTCOME MEASURE: Recurrence of neck infection. RESULTS: Three different modes of presentation were identified. Four patients presented primarily with an intrathyroidal abscess; 2 presented with recurrent deep neck infections requiring repeated drainage; and 2 presented with symptoms unrelated to the tract. Barium swallows identified the tracts in 5 of 8 patients, and telescopic hypopharyngoscopy identified the tracts in all 8 patients. Five patients were treated with complete excision of their tracts; 1 was treated with cauterization of the internal opening; and 2 were observed for symptoms related to the tracts. All 8 patients are currently asymptomatic. CONCLUSIONS: Piriform sinus tracts are rare. Most patients with tracts present with recurrent deep neck infections. Telescopic hypopharyngoscopy is the diagnostic modality of choice. Endoscopic cauterization is recommended as the initial therapy in symptomatic patients, with complete excision reserved for recurrences. Observation is appropriate for asymptomatic patients.