Objective: To evaluate the clinical efficacy of low-temperature plasma radiofrequency ablation (LPRA) in treating congenital pyriform sinus fistula (CPSF). Methods: The present study enrolled 79 pediatric patients with CPSF treated at the authors’ hospital from January 2020 to June 2024. The sample included 75 primary cases and 4 recurrent cases, all undergoing LPRA. A comprehensive documentation of the patients’ gender, age at onset, clinical manifestations, and diagnostic/therapeutic processes was conducted to summarize the diagnostic features and prognosis. Results: Among the 75 patients diagnosed with the condition for the first time, the mean age at onset was 61.9±35.4 months, including 6 neonates. Neck swelling was the initial symptom in 56 cases. Left-sided fistulas were identified in 70 cases, although 8 of these patients exhibited bilateral neck swelling. Bilateral fistulas were observed in two cases, manifesting as swelling on the left and right sides of the neck, respectively. Furthermore, one case was presented without overt swelling. 23 patients were in the acute phase at admission, with bacterial cultures performed in 18 cases: Sixteen cases were found to be positive for the infection, including four neonates. Two patients were found to be negative. The causative agents were identified as G+ cocci in 13 cases, G- bacilli in 7 cases, and multiple pathogens in 8 cases. The median length of hospital stay was 11 days, and the median duration of nasogastric tube placement was 8 days. Postoperative hoarseness developed in four cases (5.3%), and all of these cases exhibited improvement following treatment. The median follow-up duration was 37 months, during which 3 cases (4.0%) relapsed. Following the administration of symptomatic treatment, the subjects underwent a subsequent LPRA, which revealed no signs of recurrence. Among the four subjects with recurrent carotid-phrenic syndrome (CPS), two had previously undergone ligation-perforation repair anastomosis (LPRA) at other institutions, with one recurrence after this procedure; two had previously undergone open neck resection, with no recurrence after this procedure. Conclusion: CPSF manifests predominantly during childhood, primarily presenting as a cervical inflammatory mass. The location of the fistula does not necessarily correspond with the site of cervical swelling. It is well established that infections are frequently initiated by opportunistic pathogens, with Gram-positive cocci being the most prevalent. LPRA offers several advantages, including minimal trauma, low complication and recurrence rates, aesthetic outcomes, and repeatability, which makes it the preferred surgical approach for CPSF.