Piriform Sinus

recessus piriformis

The piriform sinus (pyriform fossa) is the paired lateral recess of the hypopharynx, lying on either side of the laryngeal inlet between the aryepiglottic fold medially and the thyroid cartilage and thyrohyoid membrane laterally. It is the widest part of the hypopharynx and leads inferiorly to the oesophageal inlet. Sharp foreign bodies (fish bones, chicken bones) lodge most commonly in the piriform sinus.

Region: Neck

Clinical Relevance

Clinical Notes

The piriform sinus is the most common site for pharyngeal foreign body impaction and is the preferred site of origin of piriform sinus carcinoma (hypopharyngeal cancer). Foreign bodies in the piriform sinus produce odynophagia, drooling, and inability to swallow, with lateral neck plain radiograph or CT confirming the location. Direct laryngoscopy under general anaesthesia with McGill forceps or rigid oesophagoscopy is used for removal. Piriform sinus fistula (third arch anomaly) presents as lateral neck discharge that communicates with the apex of the piriform sinus.

Pathology

Common Injuries & Conditions

Piriform Sinus Foreign Body Impaction

Sharp foreign bodies lodging in the piriform sinus produce odynophagia, drooling, and hypersalivation; CT of the neck localises the foreign body precisely and identifies complications including perforation and mediastinal air, and direct laryngoscopy under general anaesthesia achieves safe removal under vision.