Pereira Kevin D, Davies Jennifer N
Department of Otolaryngology-Head and Neck Surgery, The University of Texas Medical School at Houston 77030, USA.
Arch Otolaryngol Head Neck Surg. 2006 Oct;132(10):1119-21. doi: 10.1001/archotol.132.10.1119.
To describe the various presentations and management of piriform sinus tracts in children and to provide a treatment algorithm.
Case series.
Pediatric otolaryngology service in a tertiary care setting.
Eight pediatric patients diagnosed as having a piriform sinus tract between 1999 and 2005.
Patients were treated with surgical excision, endoscopic cauterization, or observation.
Recurrence of neck infection.
Three different modes of presentation were identified. Four patients presented primarily with an intrathyroidal abscess; 2 presented with recurrent deep neck infections requiring repeated drainage; and 2 presented with symptoms unrelated to the tract. Barium swallows identified the tracts in 5 of 8 patients, and telescopic hypopharyngoscopy identified the tracts in all 8 patients. Five patients were treated with complete excision of their tracts; 1 was treated with cauterization of the internal opening; and 2 were observed for symptoms related to the tracts. All 8 patients are currently asymptomatic.
Piriform sinus tracts are rare. Most patients with tracts present with recurrent deep neck infections. Telescopic hypopharyngoscopy is the diagnostic modality of choice. Endoscopic cauterization is recommended as the initial therapy in symptomatic patients, with complete excision reserved for recurrences. Observation is appropriate for asymptomatic patients.
描述儿童梨状窦瘘管的各种表现及处理方法，并提供一种治疗方案。
病例系列研究。
三级医疗中心的儿科耳鼻喉科。
1999年至2005年间诊断为梨状窦瘘管的8例儿科患者。
患者接受手术切除、内镜烧灼或观察治疗。
颈部感染复发情况。
确定了三种不同的表现形式。4例患者主要表现为甲状腺内脓肿；2例表现为复发性深部颈部感染，需要反复引流；2例表现出与瘘管无关的症状。8例患者中有5例通过吞钡检查发现了瘘管，8例患者均通过电子喉镜检查发现了瘘管。5例患者接受了瘘管的完全切除；1例接受了内口烧灼治疗；2例因与瘘管相关的症状接受观察。所有8例患者目前均无症状。
梨状窦瘘管较为罕见。大多数患有瘘管的患者表现为复发性深部颈部感染。电子喉镜检查是首选的诊断方法。对于有症状的患者，建议将内镜烧灼作为初始治疗方法，复发时则进行完全切除。对于无症状的患者，观察是合适的。
