Abstract: Objective　To investigate the anatomical characteristics of congenital piriform sinus fistula (PSF) in children, and design a minimally invasive surgical method.    Method   From July 2012 to July 2018, 54 cases of PSF were divided into two groups. In the traditional group the thyroid or external fistula plane approach was adopted in 34 patients, while in modified group the inferior horn of thyroid cartilage approach was adopted in 20 patients. The anatomical characteristics about PSF were then studied. The following data were compared and analyzed between the two groups: the incision length, surgical duration, intraoperative blood loss,  hospitalization length, the rate of radical operation, complication and postoperative recurrence.　Results　Fistula was divided into infundibular and transitional parts. Infundibular was located behind or on the side of the posteroinferior cornu. Fistula had three types. Type I had terminal at the upper pole of the thyroid, Type II had terminal reaching the skin via the thyroid, and Type III had terminal reaching the skin directly. The incision length, surgical duration, intraoperative bleeding, hospitalization length and recurrence rate in the modified group were lower than those in the traditional group (P<0.01). After following-up of 6~18 months, the recurrence rate was 29.4% in the traditional group, but no recurrence was found in the modified group.  Conclusion　Piriform fossa fistulectomy is performed through posteroinferior cornu with advantages such as short operation path, quick recovery, and low recurrence rate. It is a better choice in management of PSF owing to its safety and effectiveness. 

Key words: Pyriform sinus fistula, 　 Thyroid cartilage, 　Child, 　Cervical abscess