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.


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.