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

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. 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. (C) 2008 Elsevier Inc. All rights reserved.