Infected Piriform Sinus Fistula and Cyst in a Neonate

DOI 2 Citations 26 References
  • Hori Tetsuo
    Department of Pediatric Surgery, Institute of Clinical Medicine, University of Tsukuba
  • Kaneko Michio
    Department of Pediatric Surgery, Institute of Clinical Medicine, University of Tsukuba
  • Ikebukuro Kenichi
    Department of Pediatric Surgery, Institute of Clinical Medicine, University of Tsukuba
  • Amagai Teruyoshi
    Department of Pediatric Surgery, Institute of Clinical Medicine, University of Tsukuba
  • Urita Yasuhisa
    Department of Pediatric Surgery, Institute of Clinical Medicine, University of Tsukuba
  • Goto Chikashi
    Department of Pediatric Surgery, Institute of Clinical Medicine, University of Tsukuba
  • Watanabe Seiichi
    Department of Pediatrics, Tsuchiura Kyodo General Hospital

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Other Title
  • 感染性頸部嚢胞として発症した梨状窩瘻の 1 新生児例

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Seven days after birth, a male patient presented a left lateral cervical mass with upper airway obstruction. Plain X-ray film and CT of the neck revealed a mass with an air-fluid level on the left side of the neck. A barium esophagogram did not show a minute communication between the left piriform sinus and the cyst. The cyst was punctured and antibiotics were administered. After withdrawal of local inflammation, piriform sinus cysts and fistulous communication were excised. The lower end of the cyst was adjacent to the left lobe of the thyroid gland. The fistula penetrated the inferior pharyngeal constrictor muscle to the piriform sinus at the level of the inferior horn of the thyroid cartilage. Histopathologic examination showed that the cyst wall was composed of damaged epithelium containing parathyroid tissue. Piriform sinus fistula accompanied by cervical cyst is rare in neonates. Enlargement of the cyst in neonates may cause significant obstruction of the trachea and esophagus, which necessitates prompt aspiration or drainage. Only 28 neonatal cases have been reported in literature. Patients were predominantly male (18 of 26), and tumors were almost exclusively on the left side (26 of 28). Respiratory symptoms are recognized more frequently in neonates and infants than in older pediatric subjects.

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