4TH BRANCHIAL SINUS CAUSING RECURRENT CERVICAL ABSCESS

Background: Three patients who presented with recurrent cervical absce sses were found to have a branchial sinus arising in the piriform foss a. Each patient had previously had cervical abscess drainage procedure s. Methods: A retrospective review of patients with recurrent cervical abscess and associated fourth branchial sinus was carried out. Result s: In each case: imaging and endoscopy identified a sinus tract from t he left piriform fossa. Neck exploration with hemithyroidectomy and ex cision of the sinus tract was performed without further recurrence of abscess. Conclusions: We believe these cases to represent a fourth bra nchial sinus. The relevant embryology and anatomy of the branchial app aratus is discussed and the pathways for the sinus and fistulous tract s of branchial sinus origin are reviewed. Branchial sinuses are uncomm on, but should be considered as the underlying aetiology in patients w ho present with recurrent cervical abscesses.