Fourth branchial pouch sinus: An unusual cause of pain in the neck

Objective: Diagnosis and treatment of recurrent left-sided neck pain and inflammation caused by a persistent fourth branchial pouch sinus. Case Report: A 30-year-old woman had recurrent complaints of pain and inflammation on the left side of her neck. Endoscopy and videofluoroscopy showed a blind- ending pouch sinus originating at the left pyriform sinus just anterior to the crycothyroid joint. The pouch sinus was excised from the apex of the left pyriform sinus to the isthmus of the thyroid gland. The diagnosis was a fourth branchial pouch sinus. There were no postoperative complications and the patient has no more symptoms related to the neck, face and arm. Discussion and Conclusion: Fourth branchial pouch sinuses are rare: only 40 cases have been reported in the literature. Recurrent complaints of pain and inflammation, especially on the left or anterior side of the neck, suggest the diagnosis of a fourth branchial pouch sinus and must be taken into consideration as a differential diagnosis. The surgical removal seems to be effective and provides permanent cure.