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 department of otolaryngology and surgical intensive care unit of Xuzhou Children’s Hospital from May 2020 to May 2023 were collected. The average age of the pediatric patients 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 50 mL syringe to reduce the volume of the cyst, which facilitated the separation of the cyst wall, and then the lesion was completely removed.Their intraoperative and postoperative complications and recurrence were observed. Results All the 8 pediatric patients were operated smoothly, two of them had pharyngeal fistula and hoarseness respectively after operation.The other pediatric patients recovered well and no recurrence after operation. Conclusions Intracapsular decompression-external cervical resection is an improved surgical method for the radical treatment of neonatal cystic piriform fossa fistula. Early treatment can alleviate dyspnea of the pediatric patients in time.