Does your child have recurrent red, swollen and pus-filled neck? Have you been diagnosed with a pear-shaped fistula? We understand the pain that many parents feel when they see their child suffer repeatedly like this. For children diagnosed with pyogenic fistula, there is now a national and international consensus that surgery is the only way to cure the problem. However, surgery needs to be performed when the child does not have a fever and there is no infection in the neck, this is to avoid spreading the inflammation and causing a more serious infection. Prior to surgery, the child’s neck infection can only be treated with topical changes and intravenous drips of antibiotics until the infection is under control. Our procedures are now commonly performed using supported laryngoscopic CO2 laser cautery. We have performed nearly 60 cases of supported laryngoscopic CO2 laser cautery. There were no cases of recurrence at the 2-month postoperative review, and the probability of re-cauterizing the fistula is low. For such children, we now still advocate that the child be discharged with a gastric tube and nasal feeding for 2 weeks before removing the tube. This is to avoid contamination of the wound with food residues and to reduce the risk of recurrence to a certain extent. In addition, please keep in mind the review time after discharge and come to the hospital on time. We will perform another exploration of the pear-shaped fossa under the support laryngoscope, and if the fistula is found again, cautery will be performed in time to avoid the child’s recurrence. For children with special conditions, such as multiple neck surgeries and severe lesions involving the thyroid gland, we consider still external cervical access to the pyriform fossa for fistulotomy. In such children, you need to take good care of your child after surgery, follow the doctor’s instructions to change the medication at the ENT clinic on time, and pay attention to whether there is redness, swelling, and overflow in the child’s wound, and follow up if there is any discomfort. I hope the above mentioned can provide some help to parents. We sincerely wish your child a healthy growth.