Objective:

To evaluate the clinical safety, efficacy, and recurrence management of a combined surgical approach—neck abscess incision and drainage coupled with low-temperature plasma radiofrequency ablation under laryngoscope-guided suspension laryngoscopy—for neonatal congenital pyriform sinus fistula (CPSF) at the abscess stage.

Approach:

• Study Design: Retrospective analysis of 21 neonatal abscess-stage CPSF patients at Hunan Children’s Hospital from January 2020 to January 2025.
• Patient Groups: Patients were divided into a simple drainage group (n = 7) and a combined surgery group (n = 14) based on family request.
• Metrics Compared: Operative time, blood loss, 24-hour NIPS pain score, vocal cord mobility, NFSS-8 swallowing score, hospital stay, and recurrence rate.

Key Findings:

• No significant differences in baseline variables between groups (P > 0.05).
• Combined group had longer operating time (P < 0.001) but equal blood loss (P = 0.068) and pain levels (P = 0.624).
• Lower NFSS-8 swallowing score in combined group (11.87 ± 2.94 vs. 15.29 ± 4.01, P = 0.019).
• Higher normal vocal cord movement in combined group (92.86% vs. 57.14%, P = 0.043).
• Lower 12-month recurrence rate in combined group (7.14% vs. 100%, P = 0.002).

Interpretation:

Combining neck abscess incision and drainage with Plasma Radiofrequency Ablation under Laryngoscope-guided is a safe and efficient treatment for CPSF in neonates with abscess.

Limitations:

• Non-randomized, retrospective cohort study design.
• Selection bias due to parental preference for treatment group allocation.
• Causal inferences regarding comparative efficacy cannot be drawn.

Conclusion:

This minimally invasive approach warrants further investigation in larger prospective, randomized studies.