Pyriform sinus fistula: Management with chemocauterization of the internalopening

A branchial remnant originating in the pyriform sinus causes a recurrent fi stula or abscess in the neck. In spite of excision, recurrence may result f rom inadequate removal of the fistula tract. We attempted chemocauterizatio n of the internal opening of the fistula tract with trichloroacetic acid (T CA) on direct endoscopy. This is a 6-year review of 18 patients with pyrifo rm sinus fistula. Medical history, barium esophagography, computed tomograp hy scans, operative findings, and treatment results were analyzed. By direc t endoscopy, all patients were found to have a fistula opening in the pyrif orm sinus. exclusively on the left side. In only 9 patients, the fistula tr act was identified by barium esophagography before operation. Computed tomo graphy revealed a suspicious fistula tract originating from the pyriform si nus in 8 of 10 patients. Sixteen patients were initially managed by TCA che mocauterization. There were no serious intraoperative or postoperative comp lications. Four patients had recurrent masses, which were managed by simple excision in 2 patients and repeated TCA cauterization in the other 2 patie nts with unobliterated internal openings. We recommend barium swallow study and direct endoscopy for all patients presenting with a recurrent lateral neck abscess, especially on the left side. Our results suggest that initial chemocauterization of the internal opening can be a reasonable alternative procedure for the management of pyriform sinus fistula.