title: Recurrent deep neck abscess and piriform sinus tract: a 15-year review on the diagnosis and management.
abstract: BACKGROUND
  Piriform sinus tract (PST) is a rare congenital condition. A delay in diagnosis is common leading to recurrent inflammation.
  
  
  METHODS
  A retrospective review was performed on all cases of PST treated at a tertiary referral centre between May 1997 and May 2012.
  
  
  RESULTS
  Eighteen patients were reviewed with a mean age of 5.4years at presentation (ranged from 0day to 14years). Most patients presented as acute inflammation (88.9%) and 16 had a left sided lesion. 72.2% of the PST are identified by contrast swallow study. The diagnostic yield was significantly higher if the study was done after the initial acute inflammation settled. Ultrasonography and computer tomography are less sensitive. The median duration from presentation to diagnosis was 17.6months (ranged 0-120months). Ten patients (55.6%) experienced recurrent inflammation before confirming the diagnosis. Fistulectomy alone was performed in 15 patients while an additional en-bloc hemithyroidectomy was done in 2 patients.
  
  
  CONCLUSIONS
  PST should be suspected in children presenting with a left deep neck abscess. Contrast swallow study is very effective in making diagnosis but has to be postponed after the acute inflammation settles. The condition can be effectively treated by fistulectomy without hemithyroidectomy in majority of our cases.
authors.affiliation: Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China. Electronic address: jennifermou@surgery.cuhk.edu.hk.
authors.forename: Jennifer W C
authors.initials: JW
authors.lastname: Mou
authors.affiliation: Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Kin Wai
authors.initials: KW
authors.lastname: Chan
authors.affiliation: Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Yuen Shan
authors.initials: YS
authors.lastname: Wong
authors.affiliation: Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Christoph H
authors.initials: CH
authors.lastname: Houben
authors.affiliation: Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Yuk Him
authors.initials: YH
authors.lastname: Tam
authors.affiliation: Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Kim Hung
authors.initials: KH
authors.lastname: Lee
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009333:Neck; D056144:Pyriform Sinus / Q000002:abnormalities*; D012008:Recurrence; D012189:Retrospective Studies; D013969:Thyroiditis, Suppurative / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Acute Suppurative Thyroiditis; Branchial Remnant; Deep Neck Abscess; Piriform Sinus Fistula; Piriform Sinus Tract