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Endoscopic electrocautery and fibrin obliteration of an acutely complicated pyriform fossa sinus tract in a septuagenarian

Published online by Cambridge University Press:  19 June 2017

R Heyes ,
A G Aulakh ,
R K Lingam  and
T Tatla
R Heyes*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Northwick Park Hospital, London, UK
A G Aulakh
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Northwick Park Hospital, London, UK
R K Lingam
Affiliation:
Department of Radiology, Northwick Park Hospital, London, UK
T Tatla
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Northwick Park Hospital, London, UK
*
Address for correspondence: Mr Richard Heyes, Department of Otolaryngology – Head and Neck Surgery, Northwick Park Hospital, London HA1 3UJ, UK Fax: +44 (0)208 869 5283 E-mail: [email protected]
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Abstract

Background:

Pyriform fossa sinus tracts classically present with neck abscess, recurrent infections and suppurative thyroiditis in children; acute presentation in a geriatric patient is rare.

Methods:

Case report and Medline literature review.

Case report:

A 79-year-old female presented with a left-sided neck mass and severe odynophagia of 3 days’ duration. Magnetic resonance imaging revealed a large-volume, loculated fluid collection extending throughout the deep spaces of the neck on the left, within and around the thyroid gland capsule. There was radiological evidence of internal jugular vein thrombophlebitis. Abscess incision and drainage, and endoscopic evaluation, were performed. A deeply penetrating sinus was seen in the left pyriform apex, the entrance of which was circumferentially cauterised and the lumen obliterated with fibrin glue. Following post-operative intravenous antibiotics, the patient made a complete recovery.

Conclusion:

This paper describes the first use of fibrin glue to obliterate a pyriform fossa sinus tract in an adult.

Keywords

Pyriform Fossa Sinus TractSuppurative ThyroiditisLemierre's SyndromeFibrinAdult
Type
Clinical Record
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 10 , October 2017 , pp. 933 - 936
Copyright
Copyright © JLO (1984) Limited 2017 

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References

1 James, A, Stewart, C, Warrick, P, Tzifa, C, Forte, V. Branchial sinus of the piriform fossa: reappraisal of third and fourth branchial anomalies. Laryngoscope 2007;117:1920–4CrossRefGoogle ScholarPubMed
2 Huang, YC, Peng, SS, Hsu, WC. KTP laser assisted endoscopic tissue fibrin glue biocauterization for congenital pyriform sinus fistula in children. Int J Pediatr Otorhinolaryngol 2016;85:115–19CrossRefGoogle ScholarPubMed
3 Lachance, S, Chadha, NK. Systematic review of endoscopic obliteration techniques for managing congenital piriform fossa sinus tracts in children. Otolaryngol Head Neck Surg 2016;154:241–6CrossRefGoogle ScholarPubMed
4 Josephson, GD, Black, K. A review over the past 15 years of the management of the internal piriform apex sinus tract of a branchial pouch anomaly and case description. Ann Otol Rhinol Laryngol 2015;124:947–52CrossRefGoogle ScholarPubMed
5 Kruijff, S, Sywak, MS, Sidhu, SB, Shun, A, Novakovic, D, Lee, JC et al. Thyroidal abscesses in third and fourth branchial anomalies: not only a paediatric diagnosis. ANZ J Surg 2015;85:578–81CrossRefGoogle ScholarPubMed
6 Derks, LS, Veenstra, HJ, Oomen, KP, Speleman, L, Stegeman, I. Surgery versus endoscopic cauterization in patients with third or fourth branchial pouch sinuses: a systematic review. Laryngoscope 2016;126:212–17CrossRefGoogle ScholarPubMed
7 Parker, KL, Clary, MS, Courey, MS. The endoscopic approach to a fourth branchial pouch sinus presenting in an adult. Laryngoscope 2013;123:2798–800CrossRefGoogle ScholarPubMed
8 Lwin, AA, Lohani, S. Lemierre's syndrome complicated by an infected branchial cyst. J R Coll Physicians Edinb 2010;40:308–10CrossRefGoogle ScholarPubMed
9 Piccioni, M, Bottazzoli, M, Nassif, N, Stefini, S, Nicolai, P. Intraoperative use of fibrin glue dyed with methylene blue in surgery for branchial cleft anomalies. Laryngoscope 2016;126:2147–50CrossRefGoogle Scholar
10 Cigliano, B, Cipolletta, L, Baltogiannis, N, Esposito, C, Settimi, A. Endoscopic fibrin sealing of congenital pyriform sinus fistula. Surg Endosc 2004;18:554–6CrossRefGoogle ScholarPubMed