Fistula of the fourth branchial pouch

A Rare Case Report of a Child Coexistence Thyroglossal Cyst and Second Branchial Cleft Fistulae

“…Our patient had branchial fistulae, contradicting thus the specialty literature data that show approximately 80% of branchial cleft anomalies present as a cyst andabout 95% are formed from the region of the second branchial arch [13,14].…”

Recurrent neck infection with branchial arch fistula in children

“…Fourth branchial fistulae follow a 'two-loop course', originating from the caudal end of the pyriform fossa, posterior to the fold made by the internal laryngeal nerve, and coursing inferiorly along the tracheoesophageal groove, posterior to the thyroid gland, into the mediastinum, to loop around the aorta (if on the left side) or the subclavian artery (if on the right). The fistula then ascends cephalad to pass over the hypoglossal nerve before piercing the platysma to end on the cervical neck [1,5,6]. The theory of fifth pouch (ultimobranchial body) derivation is a relatively newly proposed one, the basis of left predominance of the fistula which may be due to the asymmetric development of the fourth branchial arch, whereby it becomes part of the aortic arch on the left side while it forms the right subclavian artery on the right.…”

Histoacryl injection in the management of fourth branchial fistula

“…The most common approaches are neck dissection with hemithyroidectomy, a step ladder approach [6], and a combined approach with an oral route [6]. Conservative treatment in the form of an antibiotic is used in the preoperative stage in cases of infection.…”