Objective To investigate the surgical treatment of neonatal cystic piriform fossa fistula. Methods A total of 8 neonatal cases of cystic piriform fossa fistula admitted to the Otolaryngology Department and surgical intensive care Unit of Xuzhou Children"s Hospital from May 2020 to May 2023 were collected. The average age of the children was 16 days. Intracapsular decompression and external cervical excision were performed. After the cyst was exposed, part of the cyst fluid was extracted with a 50ml syringe to reduce the volume of the cyst, facilitate the separation of the cyst wall, and remove the lesion completely. Intraoperative and postoperative complications and recurrence were observed. Results All the 8 children were operated smoothly, 1 child had pharyngeal fistula after operation, 1 child had hoarseness, the rest of the children recovered well after operation, and there was no recurrence cases. Discussion Intracapsular decompression and external cervical resection is an improved surgical method for the radical treatment of neonatal cystic piriform fossa fistula. Early treatment can alleviate dyspnea in time.