Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2022, Vol. 36 ›› Issue (5): 24-29.doi: 10.6040/j.issn.1673-3770.0.2021.413

Previous Articles    

Endoscopic plasma ablation in 45 cases of congenital piriform sinus fossa fistula with different degrees of inflammation

ZHU Jing, ZHANG Rui, ZHAO Yuan, LI Yang, FAN Mengyun, ZHAO Yu   

  1. Department of Otorhinolaryngology & Head and Neck Surgery, Xi'an Children's Hospital, Xi'an 710003, Shaanxi, China
  • Published:2022-09-20

PDF (PC)

191

Abstract: Objective To observe the postoperative efficacy and complications of endoscopic low-temperature plasma ablation for congenital piriform sinus fossa fistula(CPSF)in children with different inflammatory stages and explore the selection of surgical indications and the judgment of postoperative cure criteria. Methods The clinical data of 45 patients with congenital pyriform sinus fistula treated in our department in the past 3years were retrospectively analyzed. According to the clinical characteristics, it was divided into early infection, abscess, and inflammatory quiescence stages. All children were treated with low-temperature plasma under endoscopic guidance. The curative efficacy was observed. Results All children were followed up for 6 months to 3 years. A total of 33 cases(73.3%)were cured. In 17 cases, the secondary endoscopic exploration was completed, the internal fistula was closed, and no abnormalities were found on a postoperative B-ultrasound examination. Sixteen children underwent only B-ultrasound follow-up and no second surgical exploration, and no abnormalities were noted. Eleven cases(24.4%)improved. None underwent a second endoscopic exploration, and postoperative B-ultrasound follow-up showed microtubule residue but no clinical symptoms during more than 6 months of follow-up. One case(2.3%)was not cured. In this case, endoscopic exploration was completed, the internal fistula was closed, and a B-ultrasound reexamination showed microtubule residue. The neck of the affected side became re-infected 7 months postoperative, but it recovered after antibiotic treatment. The patient was followed up for 1 year without recurrence and remains under surveillance. Four children had early inflammation; of them, 2 had neck abscesses soon after surgery that were cured after incision and drainage. Among 15 cases in the abscess stage, no neck infection occurred during postoperative follow-up. Among the 26 children in the inflammatory quiescence stage,1 had recurrent neck swelling on the affected side at 7 months postoperative that recovered after anti-infective treatment. One patient(inflammatory quiescence stage)developed hoarseness postoperatively and recovered after 1 month of follow-up, while the rest had no complications. Conclusion Endoscopic low-temperature plasma ablation for the treatment of CPSF fistula in the period of quiescent inflammation and acute infection is effective, safe, and minimally invasive, making it the first choice for the initial treatment of CPSF.

Key words: Congenital pyriform sinus fistula, Endoscopic, Low temperature plasma, Curative effect

CLC Number: 

  • R762
[1] Sandborn WD, Shafer AD. A branchial cleft cyst of fourth pouch origin [J]. J Pediatr Surg, 1972, 7(1):82. doi: 10.1016/0022-3468(72)90421-6.
[2] Nicoucar K, Giger R, Jaecklin T, et al. Management of congenital third branchial arch anomalies: a systematic review[J].Otolaryngol Head Neck Surg, 2010, 142(1):21-28. doi: 10.1016/j.otohns.2009.09.001.
[3] Nicoucar K, Giger R, Pope HG Jr, et al. Management of congenital fourth branchial arch anomalies: a review and analysis of published cases [J]. J pediatr Surg, 2009, 44(7):1432-1439. doi: 10.1016/j.jpedsurg.2008.12.001.
[4] 刘涛,温哲,梁奇峰,等. 儿童梨状窝瘘的诊断和治疗[J].中华医学杂志,2016,96(39):3156-3159. doi:10.3760/cma.j.issn.0376-2491.2016.39.009. LIU Tao, WEN Zhe, LIANG Qifeng, et al. Diagnosis and treatment of piriform fossa fistula in children[J] National Medical Journal of China,2016, 96(39): 3156-3159. doi:10.3760/cma.j.issn.0376-2491.2016.39.009.
[5] Li W, Xu H, Zhao L, Li X. Branchial anomalies in children: a report of 105 surgical cases[J]. Int J PediatrOtorhinolaryngol, 2018, 104:14-18. doi: 10.1016/j.ijporl.2017.10.035. Epub 2017 Oct 29.
[6] James A, Stewart C, Warrick P. Branchial sinus of the piriform fossa: reappraisal of third and fourth branchial anomalies[J]. Laryngoscope, 2007, 117(11):1920-1924. doi: 10.1097/MLG.0b013e31813437fc.
[7] 杨红,滕以书,李兰,等.新生儿梨状窝瘘3例并文献复习[J].山东大学耳鼻喉眼学报,2021,35(4):40-44. doi: 10.6040/j.issn.1673-3770.0.2020.385. YANG Hong, TENGYishu, LI Lan, et al. Pyriform sinus fistula in neonates: a clinical report of 3 cases and literature review[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(4):40-44. doi: 10.6040/j.issn.1673-3770.0.2020.385.
[8] 张琪,刘百灵,赵昱,等.儿童先天性梨状窝瘘的临床及超声影像特征[J].中国临床医学影像杂志,2021,32(8):579-582. doi:10.12117/jccmi.2021.08.012. ZHANG Qi, LIU Bai-ling, ZHAO Yu, et al. The clinical and ultrasonographic features of congenital pyriform sinus fistula in children[J]. Journal of China Clinic Medical Imaging, 2021,32(8):579-582. doi:10.12117/jccmi.2021.08.012.
[9] Lin CY, Hsiao TY, Hsu WC, et al. Pathognomonic ultrasonic images of congenital pyriform sinus fistula in Children[J]. Clin Otolaryngol, 2021, 46(1):110-115. doi: 10.1111/coa.13642. Epub 2020 Sep 14.
[10] 齐银静,许云峰. 48例先天性梨状窝瘘的超声图像回顾分析[J]. 影像研究与医学应用, 2021(7):47-48. doi: 10.3969/j.issn.2096-3807.2021.07.022. QI Yinjing, XU Yunfneg. Retrospective analysis of ultrasound images in 48 cases of congenital piriform fossa fistula[J]. Journal of Imaging Research and Medical Applications.2021,7:47-48. doi: 10.3969/j.issn.2096-3807.2021.07.022.
[11] 张号绒,侯艳青,许云峰,等.彩色多普勒超声对儿童鳃裂畸形的诊断价值[J]. 临床小儿外科杂志,2021(5):464-468. doi:10.12260/Icxewkzz.2021.05.013. ZHANG Haorong, HOU Yanqing, XU Yunfeng, et al. Diagnostic value of color Doppler ultrasonography in children with branchial cleft deformity[J]. J Clin Ped Sur, 2021, 5:464-468. doi:10.12260/Icxewkzz.2021.05.013.
[12] Derks LS, Veenstra HJ, Oomen KP, et al. Surgery versus endoscopic cauterization in patients with third or fourth branchial pouch sinuses: a systematic review[J]. Laryngoscope, 2016, 126(1):212-217. doi: 10.1002/lary.25321. Epub 2015, 9 15.
[13] 窦倩雯,田秀芬. 低温等离子射频消融治疗216例先天性梨状窝瘘的临床分析[J]. 山东大学耳鼻喉眼学报,2021(2):43-49. doi:10.6040/j.issn.1673-3770.1.2020.092. DOU Qianwen, TIAN Xiufen. Clinical analysis of 216 cases of congenital pyriform sinus fistula treated by radiofrequency ablation[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 2:43-49. doi:10.6040/j.issn.1673-3770.1.2020.092.
[14] Jordan JA, Graves JE, Manning SC, et al. Endoscopic cauterization for treatment of fourth branchial cleft sinuses[J]. Arch Otolaryngol Head Neck Surg, 1998,124(9):1021-1024. doi: 10.1001/archotol.124.9.1021.
[15] 陈伟,倪坤,顾美珍,等.显微支撑喉镜下低温等离子微创治疗儿童先天性梨状窝瘘[J]. 中国耳鼻咽喉颅底外科杂志,2020(5):554-558. doi:10.11798/j.issn.1007-1520.202005016. CHEN Wei, NI Kun, GU Meizhen, et al. Minimally invasive treatment of congenital pyriform sinus fistula in children by low temperature plasma under microscopic laryngoscope[J] Chinese Journal of Otorhinolaryngology-Skull Base Surgery,2020,26(5):554-558. doi:10.11798/j.issn.1007-1520.202005016.
[16] Xia L, Lin Z, Lin X, et al. The treatment of congenital pyriform sinus fistula: a single-center experience[J]. Pediatr Surg Int, 2020, 36(7):779-788. doi: 10.1007/s00383-020-04676-2.
[17] Wang S, He Y, Zhang Y, et al. CO2 laser cauterization approach to congenital pyriform sinus fistula[J]. J Pediatr Surg, 2018, 53(7):1313-1317. doi: 10.1016/j.jpedsurg.2017.06.020. Epub 2017 Jun 28.
[18] 黄舒玲,陈良嗣,许咪咪,等.内镜CO2激光烧灼术治疗先天性梨状窝瘘与颈部开放术式的对照研究[J].中华耳鼻咽喉头颈外科杂志,2021,56(6):619-625. doi:10.3760/cma.j.cn115330-20200805-00647. HUANG Shuling, CHEN Liangsi, XU Mimi, et al. A comparison between endoscopic CO2 laser cauterization and open neck surgery in the treatment of congenital piriform fistula[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2021, 56(6):619-625. doi:10.3760/cma.j.cn115330-20200805-00647.
[19] 吴伟,吕志葆.儿童颈部梨状窝瘘诊治进展[J].国际儿科学杂志,2014,41(4):418-420. doi:10.3760/cma.j.issn.1673-4408.2014.04.023. WU Wei, LYU Zhibao. Progress in diagnosis and treatment of pyriform[J]. Int J Pediatr, 2014, 41(4):418-420. doi:10.3760/cma.j.issn.1673-4408.2014.04.023.
[20] 鲁秀敏,桑建中,张亚民,等. 低温等离子治疗先天性梨状窝瘘57例[J]. 中国微创外科杂志,2020,20(8):730-732. doi:10.3969/j.issn.1009-6604.2020.08.014. LU Xiumin, SANG Jianzhong, ZHANG Yamin, et al. Low Temperature Plasma Therapy for 57 Cases of Congenital Pyriform Sinus Fistula[J]. Chin J Min Inv Surg, 2020(8):730-732. doi:10.3969/j.issn.1009-6604.2020.08.014.
[21] Cha W, Cho SW, Hah JH, et al. Chemocauterization of the internal opening with trichloroacetic acid as first-line treatment for pyriform sinus fistula[J]. Head Neck, 2013, 35(3):431-435. doi: 10.1002/hed.22998. Epub 2012 Apr 12.
[22] Wang L, Sang J, Zhang Y, et al. Evaluation of endoscopic coblation treatment for obliteration of congenital pyriform sinus fistula[J]. Acta Otolaryngol, 2018, 138(6):574-578. doi: 10.1080/00016489.2017.1420916.
[23] Wang S, He Y, Zhang Y, et al. CO2 laser cauterization approach to congenital pyriform sinus fistula[J]. J Pediatr Surg, 2018, 53(7):1313-1317. doi: 10.1016/j.jpedsurg.2017.06.020.
[24] 李晓艳,刘大波,陈良嗣,等.儿童先天性梨状窝瘘诊断与治疗临床实践指南[J].临床耳鼻咽喉头颈外科杂志,2020,34(12):1060-1064. doi:10.13201/j.issn.2096-7993.2020.12.002. LI Xiaoyan, LIU Dabo, CHEN Liangsi, et al.Clinical practice guidelines for the diagnosis and management of congenital pyriform sinus fistulain children[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2020, 34(12):1060-1064. doi:10.13201/j.issn.2096-7993.2020.12.002.
[1] LI Dingbo, TANG Zhiyuan, DENG Zhiyi, ZENG Xianhai, ZHANG Qiuhang, WANG Zaixing. Curative effect analysis of low-temperature plasma radiofrequency ablation in 27 cases of drug-related rhinitis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(5): 11-17.
[2] LI Lijie, TIAN Xiufen. Forty cases of early glottic cancer treated by CO2 laser surgery combined with radiofrequency ablation [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(4): 79-85.
[3] WANG Huan, HU LiOverview,YU HongmengGuidance. Research progress of olfactory dysfunction in chronic rhinosinusitis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 43-49.
[4] CAO XuanOverview,XIAO Xuping, LI YunqiuGuidance. Advances in the application of hyaluronic acid in chronic sinusitis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 104-109.
[5] QIN Ming, SUN Zhanwei, WANG Weiwei, LI Shichao, WU Tianyi, WANG Guangke. Efficacy of alkaline isotonic saline in laryngopharyngeal reflux symptom-positive or finding score-positive patients with chronic rhinosinusitis following endoscopic sinus surgery [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 147-153.
[6] CHEN Shiqin, WEI Pingcun, HU Yunlong, HU Jinwang. Effects of three different nasal uses of glucocorticoid on mucosal outcome after endoscopic sinus surgery [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 195-201.
[7] CHEN Kun, LU Hui, HUANG Qi, LI Lei, MENG Guozhen, YANG Jun, HOU Dongming. Clinical diagnosis and treatment of congenital nasal sinus mass in children [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(1): 81-85.
[8] LONG Ting, LIU Yuwei, WANG Shengcai, ZHANG Jie, LI Yanzhen, ZHANG Xuexi, LIU Qiaoyin, LIU Zhiyong, SUN Nian, NI Xin. A clinical analysis on children with congenital pyriform sinus fistula treated through microscopic laryngoscopy with CO2 laser cauterization [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(1): 125-130.
[9] ZHANG Min, LIU Yongliang, SONG Daoliang, HAN Xuefeng, FENG Xinrong, ZHAO Yunpei. A comparative study on the treatment of severe chronic hypertrophic rhinitis by modified inferior turbinate plasty under nasal endoscopy and low-temperature plasma ablation with fracture displacement of the inferior turbinate [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(6): 83-88.
[10] ZHOU YuxiangOverview,MIAO Beiping, LU YongtianGuidance. Treatment progress of endoscopic surgery for first diagnosed nasopharyngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(6): 108-112.
[11] JIN Xin, SHI Lei, JIN Mengyuan. Application of decellularized dermal matrix after benign tumor resection in the nasal sinus [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(5): 17-22.
[12] QIN He, WAN Baogang, WANG Hongli, ZHAO Benqi. Computed tomography-based preoperative diagnosis of fungal ball sinusitis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(5): 32-35.
[13] MA Yifei, YU Guodong, XIAN Zhipeng, HE Xingchen, GU Ping, CHEN Zili. Evaluation of the effect of voice training on vocal cord polyp surgery [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(3): 54-58.
[14] WU ZebinOverview,QIU QianhuiGuidance. Endoscopic surgery for skull base lesions in pediatric patients [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(3): 112-117.
[15] LI Jianzhong, ZHOU Yongrui, LI Huiying, LI Miaobian, SUN Yidi, QIU Qianhui. A study of low-temperature plasma ablation for the treatment of benign thyroid nodules under ultrasound guidance [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(2): 34-38.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Website Copyright: Editorial Office of Journal of Otolaryngology and Ophthalmology of Shandong University
Address: No.27 Shanda South Road, Jinan, Shandong, China. Post code: 250100 Tel: +86-0531-88366912 Email: ebhxb@sdu.edu.cn Supported by Beijing Magtech Co.Ltd