Your child suddenly has a red, swollen, painful neck, often with fever and sore throat? Do you feel a lump next to the laryngeal node, or a diffuse swelling of the neck, or in severe cases, an abscess encroaching on the skin and breaking down? Do you even notice that your child is struggling to breathe because of the size of the lump, and that there is a “silky” sound when breathing? Don’t worry, your child may have a congenital pear-shaped fistula. Pear-shaped fistula is a congenital malformation of the gill fissure, which is formed when the pharyngeal bursa or gill arch is abnormally pierced or incompletely atretic in early embryonic life, and more than 80% of them develop in childhood. Many neck abscesses, acute thyroiditis, and thyroid abscesses are actually caused by pyriform fistulas. If you notice any of these problems in your child, please bring your child to the hospital promptly. Based on the medical history and professional examination, the doctor will perform laryngoscopy, soft tissue ultrasound of the neck, ultrasound of the thyroid gland, and enhanced MRI of the neck as needed by the child to assist the doctor in diagnosis. At the same time, it is used to clarify the site, scope, travel characteristics, boundaries, blood supply and other conditions of the lesion. The doctor can make a preliminary diagnosis by combining the medical history, physical examination and relevant ancillary tests; however, the final diagnosis of pyriform fistula requires a laryngoscopic exploration of the pyriform fossa under general anesthesia to investigate whether there is an internal fistula in the pyriform fossa, in order to clarify the indications for surgery and to finalize the surgical approach. Symptoms are relieved by drainage of the abscess, but are prone to recurrence. Therefore, the treatment of pear fossa fistula is based on thorough surgery during the quiescent inflammation period. However, in the presence of acute infection or abscess formation, the abscess must be drained and the infection controlled before elective surgery is performed. The CO2 laser cautery method for the treatment of pyriform fistula is a mature and experienced surgical technique that involves the separation of nerves, removal of the thyroid gland or thyroid cartilage and lymph nodes, which is more traumatic, has a higher chance of infection and recurrence, and affects the aesthetics of the child’s neck. The procedure is simple, takes a short time, is aesthetically pleasing (no scarring of the neck), reduces the risk of damaging important anatomical structures, and is more effective than traditional methods (recurrence rate of about 35% with traditional methods). The children were re-examined by general anesthesia-supported laryngoscopy 1-3 months after surgery, and most of them showed closure of the internal fistula and local scar formation; in all cases, there was no significant swallowing difficulty, no hoarseness, no choking, no dislocation of the cricoarytenoid joint or tooth loss, and the patients and their families were satisfied with the appearance of the neck. Successful and satisfactory surgery is what every doctor and parents look forward to the most. However, there are still some things you need to pay attention to after surgery to better help your child recover. Some children need to follow the doctor’s prescription for a transgastric tube diet (at least 10 days) after surgery, not through the mouth, which can help the wound healing and reduce the chance of infection; another oral care, special positions and related medication treatment are needed. One-day general anesthesia surgery is required in the ENT ward 1-3 months after surgery to check the wound healing and determine the prognosis of the child. We hope the above information will be helpful to you and your child, and we sincerely wish your child a healthy and happy growth.