Pyriform fistula is a congenital condition that is relatively rare and is caused by abnormal penetration of the gill sulcus and pharyngeal sac during embryonic development, or by incomplete closure. Patients may present locally with large cysts, sometimes compressing the airway, and some patients may develop a persistent fistula in the neck, with fluid flow and recurrent cellulitis. When the disease is detected, it is necessary to go to the hospital as soon as possible to improve the relevant tests for treatment, which is mainly antibiotic treatment, followed by surgical excision or endoscopic cautery, of which surgical excision is mainly suitable for recurrent cases, while endoscopic cautery is mainly seen in the first cases, which is less invasive. The choice of the procedure depends on the patient’s condition.