Surgical approach and treatment for the orifice of a pyriform sinus fistula: a case report and literature review

A 4-year-old girl underwent an open-neck surgical procedure for a recurrent pyriform sinus fistula (PSF). A catheter could not be inserted through the endoscope into the opening of the fistula. An open-neck surgical procedure with coring out of the fistula stained with a dye revealed that the fistula was missed near the upper lobe of the left thyroid. A guide wire was successfully inserted via the endoscope into the fistula, and the wire was gripped with forceps under fluoroscopic guidance and removed. As a modification of the surgical approach and treatment for the orifice of the PSF, a catheter was exchanged through the guide wire, and a nylon thread was passed into the catheter. The tip of the nylon thread from the oral side was fastened and fixed to a gauze ball. After removing the nylon thread, the orifice of the sinus fistula was recognized and sutured. She was discharged uneventfully and has done well without a postoperative recurrence for 12 months.