Department of Otolaryngology-Head and Neck Surgery, Gunma University Graduate School of Medicine.
Ann Otol Rhinol Laryngol. 2021 Jun;130(6):629-635. doi: 10.1177/0003489420966348. Epub 2020 Oct 21.
Suppurative acute thyroiditis is caused by pyriform sinus fistula (PSF), and PSF frequently elicits deep neck abscess. However, complete fistulectomy is the ideal management of PSF, and studies on surgical findings of PSF are exceedingly rare. This study aimed to reveal the origins of PSF, each route, and clinical presentation.
This is a multicenter study. We have conducted 19 complete fistulectomies of PSF in Japan, analyzed routes of the fistulas, estimated the origins, and investigated their histological and clinical findings.
No recurrence was observed in all cases. Five of 12 cases showed thymic and/or parathyroid tissues around the fistulas, passing inside the inferior horn of thyroid cartilage, were regarded as having 3rd pouch origin, and tended to have low frequency of severe deep neck abscess. The remaining 7 cases originated from the 4th pouch running outside of the horn and showed frequent severe infection.
PSF have 2 different routes depending on their generation and may present different clinical manifestations.
化脓性甲状腺炎由梨状窝瘘（PSF）引起，PSF 常引发深部颈脓肿。然而，PSF 的理想治疗方法是完全瘘管切除术，关于 PSF 的手术发现的研究极为罕见。本研究旨在揭示 PSF 的起源、各个途径和临床表现。
这是一项多中心研究。我们在日本进行了 19 例 PSF 的完全瘘管切除术，分析了瘘管的途径，估计了起源，并研究了其组织学和临床发现。
所有病例均无复发。12 例中有 5 例瘘管周围有胸腺和/或甲状旁腺组织，穿过甲状腺软骨下角内侧，被认为起源于第 3 囊，且深部颈脓肿的发生率较低。其余 7 例起源于外角外侧的第 4 囊，感染较为严重。
PSF 的发生有两种不同的途径，可能表现出不同的临床表现。
