Management of anomalies of the third and fourth branchial pouches

Kevin D. Pereira, Garrett G. Losh, Dwight Oliver, Michael D. Poole

Research output: Contribution to journalArticlepeer-review

72 Scopus citations


Third and fourth branchial pouch anomalies are rare and usually present as lateral neck masses, abscesses or with acute suppurative thyroiditis. An opening in the piriform sinus can be identified in most cases. We present four cases of fourth branchial pouch sinuses, one of a third branchial cyst and discuss our management. Cannulation of the sinus tract at laryngoscopy, followed by complete surgical excision, via a modified oblique thyrotomy above the cricothyroid joint after detaching the inferior constrictor was used to treat the fourth branchial pouch anomalies. This surgical approach adequately exposes the piriform sinus apex and also affords protection to the recurrent laryngeal nerve. The third pouch cyst and tract were excised at the level of the thyrohyoid membrane. There were no complications or recurrences.

Original languageEnglish (US)
Pages (from-to)43-50
Number of pages8
JournalInternational Journal of Pediatric Otorhinolaryngology
Issue number1
StatePublished - Jan 2004


  • Branchial
  • Cyst
  • Fistula
  • Piriform sinus

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Otorhinolaryngology


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