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Oyachi N, Numano F, Saito T, Hoshiai M, Koizumi K. Transoral traumatic perforation of the pyriform sinus by a marker pen: report of an infant case. Surg Case Rep 2023; 9:199. [PMID: 37968535 PMCID: PMC10651590 DOI: 10.1186/s40792-023-01781-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/09/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Perforation of the pyriform sinus, included in hypopharyngeal injury, is a rare condition typically caused by iatrogenic factors. We present a case of an infant who developed deep cervical and mediastinal abscesses due to a traumatic pyriform sinus perforation caused by accidentally falling with a marker pen in the mouth. CASE PRESENTATION An 11-month-old healthy male infant fell on a trampoline with a marker pen in his mouth. The patient developed swelling in the neck 3 h after the incident and was taken to a regional general hospital. Although a laryngoscopy showed no perforation in the oral cavity or posterior pharynx, a computed tomography (CT) scan revealed significant emphysema extending from the cervix to the mediastinum. The patient was transferred to our tertiary hospital and admitted to the intensive care unit, where he was mechanically ventilated, and antibiotic therapy was initiated. On day 3 of admission, a CT scan revealed deep abscesses in the cervical and upper posterior mediastinum with pneumomediastinum. Although his respiratory status stabilized and he was temporarily weaned, the fever recurred. Pharyngoesopagography revealed significant leakage of contrast from the left pyriform sinus to the mediastinum. Consequently, surgical drainage of the abscess was performed on day 10. Two low-pressure continuous suction drains were placed, one in the posterior mediastinum and the other close to the pyriform sinus. Pharyngoesophagography on postoperative day (POD) 7 demonstrated decreased contrast leakage into the posterior mediastinum. The patient was initiated on enteral nutrition through a nasogastric tube. The patient was discharged on POD 31 after the suction drains were replaced with open Penrose drains, and enteral nutrition via nasogastric tube was continued at home. The Penrose drains were removed on POD 54, and salivary leakage ceased on POD 111. CONCLUSIONS Although injuries to the oral cavity and posterior pharynx are more easily recognized, the existence of injury in the pyriform sinus can be challenging to evaluate. However, prompt and appropriate management, including intubation, antibiotic therapy, surgical drainage, and nutritional support, is critical in preventing life-threatening complications.
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Affiliation(s)
- Noboru Oyachi
- Department of Pediatric Surgery, Yamanashi Prefectural Central Hospital, 1-1-1 Kofu, Yamanashi, 409-8506, Japan.
| | - Fuminori Numano
- Department of Pediatric Surgery, Yamanashi Prefectural Central Hospital, 1-1-1 Kofu, Yamanashi, 409-8506, Japan
| | - Tomohiro Saito
- Department of Pediatrics, Yamanashi Prefectural Central Hospital, 1-1-1 Kofu, Yamanashi, 409-8506, Japan
| | - Minako Hoshiai
- Department of Pediatrics, Yamanashi Prefectural Central Hospital, 1-1-1 Kofu, Yamanashi, 409-8506, Japan
| | - Keiichi Koizumi
- Department of Pediatric Surgery, Yamanashi Prefectural Central Hospital, 1-1-1 Kofu, Yamanashi, 409-8506, Japan
- Department of Pediatrics, Yamanashi Prefectural Central Hospital, 1-1-1 Kofu, Yamanashi, 409-8506, Japan
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Abstract
OPINION STATEMENT At the University of Wisconsin, all treatment of head and neck cancer patients begins with discussion at our multi-disciplinary tumor board. Most patients with T4 disease, with existing laryngeal dysfunction, considered unlikely to complete definitive CRT or who have a high risk of persistent aspiration after non-operative management undergo total laryngectomy. A laryngeal sparing approach is attempted on most other patients. Radiotherapy is delivered over 6.5 weeks, preferably with concurrent weekly cisplatin. If the patient is hesitant of chemotherapy or has contraindications to cisplatin, concurrent cetuximab may be offered. Patients treated with RT alone are often treated to the same dose, but via an accelerated schedule by adding a 6th fraction per week. The 6th fraction is given by delivering two treatments at least 6 h apart on a weekday of the patient's choosing. We consider the following to be major risk factors for clinically significant weight loss during treatment: a 10% or greater loss of weight in the 6 months prior to starting treatment, delivery of concurrent cisplatin, and treatment of the bilateral neck with radiation. Patients who have 2-3 of these characteristics are often given gastrostomy tubes prophylactically. Patients are seen 2 weeks after completion of therapy, and then every 3 months after completion for 2 years. A CT neck and PET-CT are performed at the first 3-month visit. They are seen twice in year three, and then yearly until years 5-7. At each of these visits, we have a low threshold to present the patient at our multidisciplinary tumor board for consideration of salvage laryngectomy if there are signs of progression.
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Affiliation(s)
- Graham Campbell
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Tiffany A Glazer
- Department of Surgery - Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Randall J Kimple
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Justine Yang Bruce
- Department of Medicine - Medical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53705, USA. .,University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, USA.
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Atar Y, Atar S, Ilgin C, Anarat MEA, Uygan U, Uyar Y. Validity and Reliability of the Turkish Translation of the Yale Pharyngeal Residue Severity Rating Scale. Dysphagia 2021; 37:655-663. [PMID: 34021774 DOI: 10.1007/s00455-021-10316-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
This study aimed to assess the validity and reliability of the Turkish translation of the Yale pharyngeal residue severity rating scale. The scale measures the severity of residue in the vallecula and pyriform sinus. The original scale was translated into Turkish by two bilingual English-Turkish translators, and the Turkish version was translated back into English by two qualified professional translators to assess accuracy. The evaluators were divided into two groups (training and no-training) and two subgroups according to their experience. Intra-rater, inter-rater, and intra-class correlation coefficient measurements were analyzed by calculating agreement rates, kappa, and p values. In the analysis of the reliability, intra-class correlation coefficient values in the overall ratings for both the vallecula and the pyriform sinus were 0.9996 (95% CI 0.9992-0.9998) and 0.9997 (95% CI 0.9995-0.9999), respectively (p < 0.01). High agreement (> 95%) and perfect Fleiss kappa values were obtained for the vallecula and pyriform sinus ratings in the inter-rater initial assessments (κ = 0.959 and κ = 0.967, respectively). Perfect kappa values were found in the intra-rater results for both the vallecula and pyriform sinus (α = 0.9959 and κ = 0.9959, respectively). In the inter-rater secondary analysis, the vallecula and pyriform sinus kappa values were perfect (κ = 0.959 and κ = 0.967, respectively). In the intra-rater analysis, perfect kappa values were obtained for the vallecula and pyriform sinus in the no-training group and less-experience subgroup (κ = 0.9918 and κ = 1.0 for the vallecula, and κ = 1.0 and κ = 0.9902 for the pyriform sinus, respectively) In the inter-rater analysis, perfect kappa values were obtained for the vallecula and pyriform sinus in the no-training group and less-experience subgroup (κ = 0.9507 and κ = 0.9606 for the vallecula, and κ = 0.9836 and κ = 1.0 for the pyriform sinus, respectively). The Turkish translation of the Yale pharyngeal residue severity rating scale demonstrated high validity and reliability scores in determining pharyngeal residue location and value in the fiberoptic endoscopic evaluation of swallowing.
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Affiliation(s)
- Yavuz Atar
- Department of Otorhinolaryngology, Prof. Dr. Cemil Tascioglu City Hospital, Kaptanpaşa Mah. Darülaceze Cad. No:25, Sağlık Bilimleri Üniversitesi, Prof. Dr. Cemil Taşcıoğlu Şehir Hastanesi, KBB Kliniği Kat:6 Blok:5, Okmeydanı, Şişli, 34384, Istanbul, Turkey.
| | - Sevgi Atar
- Department of Physical Medicine and Rehabilitation, Prof. Dr. Cemil Tascioglu City Hospital, Kaptanpaşa Mah. Darülaceze Cad. No:25, Sağlık Bilimleri Üniversitesi, Prof. Dr. Cemil Taşcıoğlu Şehir Hastanesi, FTR Kliniği Kat:6 Blok:1, Okmeydanı, Şişli, 34384, Istanbul, Turkey
| | - Can Ilgin
- Department of Public Health, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Melis Ece Arkan Anarat
- Department of Otorhinolaryngology, Prof. Dr. Cemil Tascioglu City Hospital, Kaptanpaşa Mah. Darülaceze Cad. No:25, Sağlık Bilimleri Üniversitesi, Prof. Dr. Cemil Taşcıoğlu Şehir Hastanesi, KBB Kliniği Kat:6 Blok:5, Okmeydanı, Şişli, 34384, Istanbul, Turkey
| | - Ugur Uygan
- Department of Otorhinolaryngology, Prof. Dr. Cemil Tascioglu City Hospital, Kaptanpaşa Mah. Darülaceze Cad. No:25, Sağlık Bilimleri Üniversitesi, Prof. Dr. Cemil Taşcıoğlu Şehir Hastanesi, KBB Kliniği Kat:6 Blok:5, Okmeydanı, Şişli, 34384, Istanbul, Turkey
| | - Yavuz Uyar
- Department of Otorhinolaryngology, Prof. Dr. Cemil Tascioglu City Hospital, Kaptanpaşa Mah. Darülaceze Cad. No:25, Sağlık Bilimleri Üniversitesi, Prof. Dr. Cemil Taşcıoğlu Şehir Hastanesi, KBB Kliniği Kat:6 Blok:5, Okmeydanı, Şişli, 34384, Istanbul, Turkey
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Ahmadi A, Sanaei A, Jan D. "End to Side Technique": More organ preservation with less morbidity in patients with pyriform sinus apex SCC. Am J Otolaryngol 2020; 41:102505. [PMID: 32354480 DOI: 10.1016/j.amjoto.2020.102505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/02/2020] [Accepted: 04/04/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Hypopharyngeal squamous cell carcinoma (SCC) is rare, but highly aggressive. Due to the advanced stage of this cancer at the time of diagnosis, radical surgery with reconstruction of pharynx is the standard care with high morbidity and mortality rate. A safer partial pharyngectomy could also be used for invasive hypopharyngeal cancer. In this study, we investigated the short and long-term outcomes in patients with SCC of the pyriform sinus apex undergoing standard partial pharyngectomy using a new suturing technique, called end to side technique. METHODS This case series was performed on 8 patients with SCC of the pyriform sinus apex at the otorhinolaryngology clinic. All participants underwent standard partial pharyngectomy using "end to side technique". Post-operative evaluations included 6 and 12 months CT scan and 1-year barium swallow. RESULTS Of 8 patients, 7 were male (87.5%) and 1 was female (12.5%) with a mean age of 60 years old. All patients were diagnosed at stage III of hypopharyngeal cancer and cervical lymph node involvement was reported in 3 patients (37.5%). Tumor margins were negative in all patients. Fistula was reported in 2 patients (25%) which was managed using conservative treatments. CONCLUSIONS According to our study, the standard partial pharyngectomy with end to side technique is a safe and feasible method for the surgical resection of the squamous cell carcinoma of the pyriform sinus apex with good short-term and long-term outcomes.
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Bumber B, Hodzic-Redzic S, Prgomet D, Bura M, Marjanovic Kavanagh M. Spontaneous Resolution of Fourth Branchial Fistula Following Thyroid Surgery: Case Report. Indian J Otolaryngol Head Neck Surg 2019; 71:879-882. [PMID: 31742087 DOI: 10.1007/s12070-019-01588-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 01/08/2019] [Indexed: 11/30/2022] Open
Abstract
Fourth branchial pouch anomalies represent one of the rarest types of all branchial apparatus anomalies. They appear in the first lifedecade in a form of recurrent left-sided neck masses which demands surgical treatment. Accidental finding, appearance later in life and spontaneous resolving are really rare. We present a case of a 43-year-old man with accidental finding of asymptomatic fourth pouch cyst and fistula following follicular thyroid cancer surgery. The day after the surgery, suction bottle was filled with little white crumbs and the wound started to suppurate. Barium swallow revealed the presence of a fistulous canal that arose from the left pyriform sinus. Meanwhile, the pathologist confirmed the presence of a lateral neck cyst within this thyroid lobe. The patient was operated on but fistulous canal was not visualized. In the meantime, wound discharge ceased spontaneously. At 1-year follow up, the patient was still well and free from any symptoms. These anomalies may manifest not only in childhood but may stay asymptomatic for a long time. It seems that the fistula can resolve spontaneously and that conservative approach is an alternative to multiple surgical procedures.
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Affiliation(s)
- Boris Bumber
- University Department of ENT, Head and Neck Surgery, Zagreb University Hospital Center, Kišpatićeva 12, 10000 Zagreb, Croatia
| | - Selma Hodzic-Redzic
- University Department of ENT, Head and Neck Surgery, Zagreb University Hospital Center, Kišpatićeva 12, 10000 Zagreb, Croatia
| | - Drago Prgomet
- University Department of ENT, Head and Neck Surgery, Zagreb University Hospital Center, Kišpatićeva 12, 10000 Zagreb, Croatia
| | - Miljenko Bura
- University Department of ENT, Head and Neck Surgery, Zagreb University Hospital Center, Kišpatićeva 12, 10000 Zagreb, Croatia
| | - Marcel Marjanovic Kavanagh
- University Department of ENT, Head and Neck Surgery, Zagreb University Hospital Center, Kišpatićeva 12, 10000 Zagreb, Croatia
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Li Y, Lyu K, Wen Y, Xu Y, Wei F, Tang H, Chen S, Wang Z, Zhu X, Wen W, Lei W. Third or fourth branchial pouch sinus lesions: a case series and management algorithm. J Otolaryngol Head Neck Surg 2019; 48:61. [PMID: 31711544 PMCID: PMC6849311 DOI: 10.1186/s40463-019-0371-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 09/09/2019] [Indexed: 01/06/2023] Open
Abstract
Background The purpose of this study was to develop an effective management algorithm for lesions of third or fourth branchial sinuses. Study design Case series with chart review. Methods Data from patients who were identified as having third or fourth branchial pouch sinus lesions in a single institution between January 2014 and December 2018 were retrospectively collected. Results All 67 patients underwent fistulectomy. First, we classified the patients into five types based on their anatomic features. Then, we considered four optimized surgical methods and adopted the appropriate method with full consideration of the patient’s clinical characteristics. The great majority of cases occurred on the left side of the neck (68.7%) and most commonly presented as either a recurrent low-neck abscess or cutaneous discharging fistula with neck infection. Effective preoperative examination included administering contrast agent prior to a computed tomography (CT) scan and in-office laryngoscopy during the quiescent period of inflammation. Ultrasound was also very helpful in determining the presence of thyroiditis. The mean follow-up duration after excision of the lesion was 25.8 months. To date, only 1 (1.5%) recurrence and no obvious complications have been observed. Conclusion Refining fistula subtypes and adopting corresponding treatment measures can reduce the recurrence rate and improve curative effects. We propose and advocate this treatment algorithm for all third and fourth branchial pouch lesions.
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Affiliation(s)
- Yun Li
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kexing Lyu
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yihui Wen
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yang Xu
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Fanqin Wei
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haocheng Tang
- Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Siyu Chen
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhangfeng Wang
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaolin Zhu
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Weiping Wen
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wenbin Lei
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Lee T, Park JH, Sohn C, Yoon KJ, Lee YT, Park JH, Jung IS. Failed Deglutitive Upper Esophageal Sphincter Relaxation Is a Risk Factor for Aspiration in Stroke Patients with Oropharyngeal Dysphagia. J Neurogastroenterol Motil 2017; 23:34-40. [PMID: 27510474 PMCID: PMC5216632 DOI: 10.5056/jnm16028] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/01/2016] [Accepted: 06/14/2016] [Indexed: 11/23/2022] Open
Abstract
Background/Aims We attempted to examine the relationship between abnormal findings on high-resolution manometry (HRM) and videofluoroscopic swallowing study (VFSS) of the pharynx and upper esophageal sphincter (UES), and to identify the risk factors for aspiration. Methods We performed VFSS and HRM on the same day in 36 ischemic stroke patients (mean age, 67.5 years) with dysphagia. Pressure (basal, median intra bolus, and nadir), relaxation time interval of the UES, and mesopharyngeal and hypopharyngeal contractility (as a contractile integral) were examined using HRM. The parameters of VFSS were vallecular residue, pyriform sinus residue, vallecular overflow, penetration, and aspiration. The association between the parameters of VFSS and HRM was analyzed by the Student’s t test. Results Three (8.3%) and 4 (11.1%) stroke patients with dysphagia had pyriform sinus residue and vallecular sinus residue, respectively, and 5 (13.8%) patients showed aspiration. Mesopharyngeal and hypopharyngeal contractile integrals in patients with residue in the pyriform sinus were significantly lower than those in patients without residue in the pyriform sinus (P < 0.05). Relaxation time intervals in patients with aspiration were significantly shorter than those in patients without aspiration (P < 0.05), and multivariate regression analysis revealed a shorter relaxation time interval as the main risk factor for aspiration (OR, 0.03; 95% CI, 0.01–0.65; P < 0.05). Conclusions Manometric measurements of the pharynx and UES were well correlated with abnormal findings in the VFSS, and a shorter relaxation time interval of the UES during deglutition is an important parameter for the development of aspiration.
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Affiliation(s)
- Taeheon Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Jung Ho Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Chongil Sohn
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Kyung Jae Yoon
- Department of Physical and Rehabilitation, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Yong-Taek Lee
- Department of Physical and Rehabilitation, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Jung Hwan Park
- Department of Bionano Technology, Gachon University, Seongnam, Gyeonggi-do, Korea
| | - Il Seok Jung
- School of Material Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Korea
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Mendenhall WM, Amdur RJ, Morris CG, Kirwan J, Dziegielewski PT, Werning JW. Primary radiotherapy for squamous cell carcinoma of the pyriform sinus. Eur Arch Otorhinolaryngol 2015; 273:1857-62. [PMID: 26071621 DOI: 10.1007/s00405-015-3658-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 05/18/2015] [Indexed: 11/28/2022]
Abstract
The objective of this study is to report the long-term outcomes of primary radiotherapy (RT) for patients with T1-T2 squamous cell carcinomas (SCC) of the pyriform sinus. Between November 1964 and March 2008, 135 patients with T1-T2 pyriform sinus SCC were treated with primary RT at the University of Florida. Adjuvant chemotherapy was employed in 21 patients (16 %) and 62 patients (46 %) underwent a planned neck dissection. Median follow-up was 3.5 years (range 0.2-24.7 years); median follow-up on living patients was 8.3 years (range 3.8-24.0 years). The 5-year outcomes were as follows: local control, 85 %; regional control, 81 %; local-regional control, 71 %; distant metastasis-free survival, 76 %; cause-specific survival, 62 %; and overall survival, 38 %. The 5-year local control rate was 88 % for T1 cancers and 84 % for those with T2 SCCs (p = 0.5429). Sixteen patients (12 %) experienced severe late complications. Primary RT results in a high probability of cure with a relatively modest risk of severe late complications for patients with T1-T2 SCCs of the pyriform sinus.
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Affiliation(s)
- William M Mendenhall
- Radiation Oncology, University of Florida College of Medicine, 2000 SW Archer Rd., PO Box 100385, Gainesville, FL, 32610-0385, USA.
| | - Robert J Amdur
- Radiation Oncology, University of Florida College of Medicine, 2000 SW Archer Rd., PO Box 100385, Gainesville, FL, 32610-0385, USA
| | - Christopher G Morris
- Radiation Oncology, University of Florida College of Medicine, 2000 SW Archer Rd., PO Box 100385, Gainesville, FL, 32610-0385, USA
| | - Jessica Kirwan
- Radiation Oncology, University of Florida College of Medicine, 2000 SW Archer Rd., PO Box 100385, Gainesville, FL, 32610-0385, USA
| | | | - John W Werning
- Otolaryngology, University of Florida College of Medicine, Gainesville, FL, USA
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Iravani K, Bassiri Jahromi S, Ashraf MJ. Primary tuberculosis of the vallecula and pyriform sinus: a case report and review of literature. Iran J Otorhinolaryngol 2015; 27:171-5. [PMID: 25938090 PMCID: PMC4409963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 11/27/2014] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Tuberculosis (TB) is a relatively prevalent infectious disease caused by a bacterium called mycobacterium tuberculosis. It primarily involves the lungs, but it can also affect other organs causing a variety of symptoms. CASE REPORT In this report, a rare case with primary involvement of pyriform sinus and vallecula due to tuberculosis in a 74-year-old woman who complained of odynophagia for 6 months, is reported. There were no clinical or radiological pulmonary findings. CONCLUSION The authors point out the epidemiological importance of tuberculosis and the need for more suspicion when dealing with uncommon lesions to make an early diagnosis.
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Affiliation(s)
- Kamyar Iravani
- Department of Otorhinolaryngotogy. Shiraz University of Medial Sciences. Shiraz, Iran. ,Corresponding Author: Department of Otorhinolaryngotogy. Shiraz University of Medial Sciences. Shiraz, Iran. Phone: +989171910769 E-mail: iravanika @sums.ac.ir
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Parida PK, Gopalakrishnan S, Saxena SK. Pediatric recurrent acute suppurative thyroiditis of third branchial arch origin--our experience in 17 cases. Int J Pediatr Otorhinolaryngol 2014; 78:1953-7. [PMID: 25219934 DOI: 10.1016/j.ijporl.2014.08.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 07/29/2014] [Accepted: 08/24/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To describe clinical presentations, management and treatment outcomes of 17 cases of congenital pyriform sinus fistula (PSF) of third branchial arch origin presenting as left recurrent acute suppurative thyroiditis with cervical abscess. METHOD Medical record of these 17 cases (5-males, 12-females) presented during 2009-2013 were reviewed. RESULTS Average age was 9.6 years (range 3-15 years). Fistulous opening in neck was present in 10 cases (58.8%). Average number of episode of infection from first presentation to definitive diagnosis was 3 (range 2-5). All patient had history of incision and drainage (ID) of abscess (average 2, range 1-3). All cases had barium swallow and CT scan. Sixteen cases had telescopic hypopharyngoscopy. Barium swallow and telescopic hypopharyngoscopy detected PSF in 88.23% (15/17) and 100% (16/16) cases respectively. Fourteen cases were treated by transcervical excision (TE) (fistulectomy with left hemithyroidectomy), two cases were treated by endoscopic chemical cauterization (ECC) of internal opening at pyriform sinus using silver nitrate and only ID of abscess was done in one case. Success rate of TE and ECC was 93% and 100% respectively. Recurrence in one case initially treated by TE was managed successfully by ECC. CONCLUSION Presence of congenital PFS should be suspected when left-sided intra-thyroidal abscess formation occurs as gland is resistant to infection. Strong clinical suspicion, barium swallow study, telescopic pharyngoscopy and CT scan are the key to diagnosis. Both TE and ECC has comparable success rate. ECC may prove a useful and equally effective method of treatment for congenital PFS in future.
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Affiliation(s)
| | | | - Sunil Kumar Saxena
- Department of Otorhinolaryngology and Head-Neck Surgery, JIPMER, Puducherry, India
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Ahn D, Sohn JH, Kim H, Yeo CK. Clinical and microbiological differences between pyriform sinus fistulae in pediatric and non-pediatric patients. Auris Nasus Larynx 2014; 42:34-8. [PMID: 25183403 DOI: 10.1016/j.anl.2014.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 05/23/2014] [Accepted: 06/10/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To review our 15-year experience with pyriform sinus fistula (PSF) in a single institution for a better understanding of the disease, pertaining especially to symptom onset at different ages. METHODS Medical records were reviewed for all 21 PSF patients presenting between 1998 and 2012. Patients were then divided into pediatric (≤ 15 years old) and non-pediatric (>15 years old) groups according to the age at symptom onset. Clinical and microbiological features of both groups were compared. RESULTS There were 12 (57.1%) pediatric and 9 (42.9%) non-pediatric patients. It took an average of 13.1 months for the diagnosis of PSF to be confirmed in pediatric patients from the time of symptom onset, whereas the same interval was only 0.7 month in the non-pediatric group. The sensitivity of computed tomography was more than 90% in both age groups, whereas that of barium esophagography was higher in non-pediatric (50.0%) than in pediatric (28.6%) patients. Recurrence occurred after initial treatment in only three patients, all of whom were in the pediatric age group. Bacteriological studies showed that Streptococcus mitis was the most common species isolated from pediatric patients, while Klebsiella pneumoniae was the most common pathogen in the non-pediatric group. CONCLUSION Non-pediatric PSF with late onset of symptoms is more common than expected or reported in the literature so far. This form of PSF present different clinical and microbiological characteristics compared to pediatric PSF. Therefore, diagnostic and therapeutic counseling for PSF should be tailored according to the age of symptom onset.
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Affiliation(s)
- Dongbin Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jin Ho Sohn
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Heejin Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Chang Ki Yeo
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Keimyung University, Daegu, Republic of Korea
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Seo JH, Park YH, Yang SW, Kim HY. Refractory acute suppurative thyroiditis secondary to pyriform sinus fistula. Ann Pediatr Endocrinol Metab 2014; 19:104-7. [PMID: 25077095 PMCID: PMC4114048 DOI: 10.6065/apem.2014.19.2.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 05/02/2014] [Accepted: 06/10/2014] [Indexed: 11/20/2022] Open
Abstract
Acute suppurative thyroiditis is a rare disease because the thyroid gland is remarkably resistant to infection. We present a 2-year-old girl with refractory acute suppurative thyroiditis due to a pyriform sinus fistula (PSF). She complained of fever and painful anterior neck swelling. Her condition did not completely improved by multiple parenteral antibiotics along with incision and drainage. Barium esophagogram to detect PSF demonstrated no specific finding. Computed tomography scan showed air bubble superior to the left thyroid gland which indicated a possible fistula connected to the pyriform sinus. An intraoperative laryngoscopy revealed a 2-mm-sized fistula opening. The fistula was successfully treated by chemocauterization with trichloroacetic acid.
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Affiliation(s)
- Jee Hyue Seo
- Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Korea
| | - Yong Hoon Park
- Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Korea
| | - Sei Won Yang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Young Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Abstract
Pyriform sinus fistula is important despite its rarity, as it can induce a recurrent neck abscess. Most of the reported cases occur in children and the majority affect only the left side. We report a patient with a pyriform sinus fistula of the right neck in an adult, which was successfully treated by surgery. The aetiology of this entity is also discussed herein.
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Affiliation(s)
- T L Chow
- Department of Surgery, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong.
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