The fourth branchial cleft anomaly

Abstract

The fourth branchial cleft anomaly has long been postulated. A case in which a lower neck sinus tract extended under the clavicle near the subclavian vessels is presented. The distinguishing features of bronchogenic and branchogenic anomalies are discussed. It appears that unless a complication (e.g., abscess, inflammatory process) of the fourth branchial cleft sinus tract occurs within the mediastinum, mandating full exploration, the complete form of the anomaly may continue to remain undocumented.

Branchial anomalies in children

“…It is thought to be due to the more complex and longer pathway of the fourth branchial tract on this side compared with the right side. Some authors have suggested it is a result of asymmetrical vascular agenesis during embryogenesis [13].…”

A Case of Cutaneous Bronchogenic Cyst Presenting with Lymphoid Follicles

“…Not only is this location unusual in a branchial anomaly (which usually prefers the anterior border of the sternocleidomastoid muscle), but actually is favored in the bronchogenic derivative3. Although a defect in the convoluted fistular path of the fourth branchial anomaly may explain such a caudal and central presentation, the bronchogenic origin of the cyst is a more plausible explanation10. In addition, Shah et al11 showed that a total of 86 cutaneous or subcutaneous bronchogenic cysts have been reported in the English literature.…”

Stridor as a presentation of fourth branchial pouch sinus

“…Some authors have suggested it is a result of asymmetrical vascular agenesis during embryogenesis. 9 Correct diagnosis of fourth branchial anomalies by early investigation is fundamental to preventing recurrence and treatment complications. Computed tomography (CT) scanning combined with a barium swallow has been proven useful in identification of a tract 4,10,11 and its relationship to surrounding structures.…”