Fourth branchial cleft sinus: relationship to superior and recurrent laryngeal nerves

Abstract 

Objectives

1) Demonstrate the surgical anatomy of a fourth branchial cleft sinus relative to the superior and recurrent laryngeal nerves. 2) Review the diagnosis and management of a fourth branchial cleft sinus.

Design

Case Study.

Setting

Tertiary Children’s Hospital.

Patient

Three year old female who presented with a fever and painful right neck mass. CT scan demonstrated a right neck abscess containing air adjacent to the thyroid.

Intervention

Two months after initial drainage, the patient underwent enbloc excision of the sinus including the thyroid lobe with closure of the piriform sinus defect.

Main outcome measure

Intraoperative photo documentation of the anatomic relationship between the fourth branchial sinus and surrounding neural structures.

Results

The sinus tract was shown to terminate in the piriform sinus inferior to the superior laryngeal nerve.