Abstract
OBJECTIVES: To evaluate the long-term efficacy and safety of endoscopic low-temperature plasma radiofrequency ablation (coblation) for the treatment of pyriform sinus fistula (PSF) in children, and to identify risk factors associated with postoperative transient vocal cord paralysis. METHODS: A retrospective cohort study was conducted at a single tertiary pediatric center. Children with pyriform sinus fistula who underwent endoscopic coblation were consecutively enrolled. Demographic characteristics, perioperative variables, postoperative complications, and follow-up outcomes were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for postoperative transient vocal cord paralysis. RESULTS: Endoscopic coblation was successfully performed in all patients. During follow-up, the majority of children experienced no recurrent cervical infection or fistula recurrence. Endoscopic examinations confirmed complete closure of the internal opening in the pyriform sinus, indicating favorable long-term outcomes and good procedural reproducibility. Transient vocal cord paralysis occurred in some patients but resolved completely in all affected cases, with no permanent nerve injury. Multivariate logistic regression analysis identified younger age and elevated preoperative white blood cell counts as independent risk factors for transient vocal cord paralysis. CONCLUSIONS: Endoscopic coblation is a safe, effective, and repeatable minimally invasive treatment for pediatric PSF, with low recurrence rates and stable long-term outcomes. Postoperative transient vocal cord paralysis is a relatively common but reversible complication, closely associated with younger age and elevated preoperative inflammatory status. These risk factors suggest that intraoperative strategies, such as adjusting ablation depth in very young children and ensuring adequate thermal dissipation, may help mitigate this risk.