title: Fourth branchial cleft sinus: relationship to superior and recurrent laryngeal nerves.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Case Study.
  
  
  METHODS
  Tertiary Children's Hospital.
  
  
  METHODS
  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.
  
  
  METHODS
  Two months after initial drainage, the patient underwent enbloc excision of the sinus including the thyroid lobe with closure of the piriform sinus defect.
  
  
  METHODS
  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.
authors.affiliation: Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA 15213-2583, USA.
authors.forename: Belinda A
authors.initials: BA
authors.lastname: Mantle
authors.forename: Todd D
authors.initials: TD
authors.lastname: Otteson
authors.forename: David H
authors.initials: DH
authors.lastname: Chi
mesh_terms: D001934:Branchial Region / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004724:Endoscopy; D005260:Female; D005402:Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D006801:Humans; D011859:Radiography; D012009:Recurrent Laryngeal Nerve / Q000002:abnormalities*; D013577:Syndrome; D013965:Thyroidectomy / Q000379:methods