Surgical procedure
Generally, we do not recommend palliative endoscopic cauterization since
this noninvasive technique also shows high recurrence rate. Most
surgeries were performed after at least a couple of months until the
final episodes of acute infection.
Prior to fistulectomy, a crystal blue dye was injected using a feeding
tube for neonates by direct laryngoscopy under general anesthesia to
find the fistula easily at fistulectomy. In fistulectomy, the inferior
constrictor muscle of the pharynx at the affected side was widely
exposed initially from the superior pole of the thyroid gland to the
front and side of larynx. The inferior horn of the thyroid cartilage was
detected; then, a filamentary object dyed by crystal blue was detected
around it. In most cases, the fistula could not be found by the naked
eyes in the scar tissue after severe recurrent infection so that the
microscope was essential to trace the fistula. Next, the fistula was cut
before the hypopharynx with double ligatures, and the superior one-third
of the unilateral robe of the thyroid gland was also dissected with the
fistula.