title: Pyriform sinus malformations: a cadaveric representation.
abstract: OBJECTIVE
  The most important aspects in management of pyriform sinus malformations are awareness of the diagnosis, familiarity with the clinical manifestations, and complete surgical excision of the entire tract. Pyriform sinus anomalies are the least common branchial apparatus malformations and present anatomically as sinus tracts with or without cystic dilatation. The clinical presentations can include lateral neck mass, thyroid abscess, suppurative thyroiditis, retropharyngeal abscess, neonatal airway obstruction, and even carcinoma. Recurrent symptoms after surgery suggest incomplete identification and excision of the tract.
  
  
  METHODS
  Cadaveric dissections were performed to show both the proposed embryologic course and clinical manifestations of third and fourth branchial apparatus pyriform sinus anomalies.
  
  
  RESULTS
  Illustrations and digital camera images of the cadaveric models are presented to explain the course of pyriform sinus fistula tracts.
  
  
  CONCLUSIONS
  The authors discuss 3 case presentations of pyriform sinus anomalies with emphasis on their proposed embryologic origin and anatomic basis for surgical management. Surgical excision is the mainstay of therapy. Understanding the embryologic basis for pyriform sinus malformations aids in recognition of the diagnosis despite the myriad of clinical presentations. Laryngoscopy with sinus cannulation facilitates removal of the entire sinus tract with preservation of the recurrent and superior laryngeal nerves.
authors.affiliation: Division of Pediatric Surgery, Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: James P
authors.initials: JP
authors.lastname: Franciosi
authors.forename: Linda L
authors.initials: LL
authors.lastname: Sell
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Conley
authors.forename: David L
authors.initials: DL
authors.lastname: Bolender
mesh_terms: D000038:Abscess / Q000473:pathology; D000293:Adolescent; D000402:Airway Obstruction / Q000473:pathology; D001934:Branchial Region / Q000002:abnormalities*; D001984:Bronchial Neoplasms / Q000473:pathology; D002102:Cadaver; D002648:Child; D005260:Female; D006801:Humans; D007013:Hypopharynx / Q000002:abnormalities*; D007231:Infant, Newborn; D007830:Larynx / Q000002:abnormalities; D008297:Male; D008953:Models, Anatomic; D010610:Pharyngeal Neoplasms / Q000473:pathology; D017703:Retropharyngeal Abscess / Q000473:pathology; D013969:Thyroiditis, Suppurative / Q000473:pathology