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This report presents a case of a six-year-old male patient with recurrent left-sided neck abscesses who presented four times over a span of two years. At each presentation, the child had developed left-sided neck swelling, pain, and fevers that required hospital admission. In the patient's most recent admission in 2020, a fourth branchial cleft anomaly was confirmed on CT, and the patient was taken to the operation theatre for ultrasound-guided aspiration and cauterisation of the sinus fistula tract under direct pharyngoscopy. This allowed for definitive management of the area and, to date, has prevented any recurrence. Although fourth branchial anomalies are rare within overall branchial arch pathologies, this case highlights the importance of considering this to be a differential diagnosis in a patient presenting with recurrent neck abscesses, particularly in children., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Qin et al.)

The purpose of this work was to determine the epidemiology and the predictive factors of success of the surgical management of fourth branchial anomalies. This is a multicentric retrospective review from 1998 to 2016 of patients who presented with an endoscopically-confirmed fourth branchial pouch anomaly. Data were analyzed according to sex, age, clinical features, number of recurrences, treatment modalities (endoscopic and/or cervicotomy), post-operative complications and follow-up. Fifty-two children have been included. The average age at diagnosis was 4.5 years. Among them, 73.1% were female, 11.4% were neonatal forms; 94.2% of lesions were left-sided; 75% of patients presented a cervical abscess as first symptom, and 7.7% of children presented with dyspnea. Average time between first symptoms and management was 9.5 months. Management was endoscopic in 73.1% of patients (laser in 84.2%, coagulation in 15.8%) with about a third of recurrence after one procedure. Overall success of endoscopic procedures reached 84.2%. A cervical open surgery was performed in 26.9% as first line treatment. Overall success of cervicotomy reached 85.7%. No complications of endoscopic surgery have been identified. There were 35.7% complications of cervicotomy (2 recurrent nerve palsy, 2 keloid scars, 1 pharyngostoma). An association was proved between recurrences and initial abscess (OR = 2.44), and with age between 3 and 5 (OR = 4). Endoscopic treatments appear to be effective in first line approach in the management of fourth branchial anomalies, offering an excellent efficiency with rare complications. We identified two risk factors of recurrence: age between 3 and 5 years old and history of cervical abscesses. IV. [ABSTRACT FROM AUTHOR]

Pyriform sinus fistula is a rare congenital anomaly affecting the third or fourth branchial arches. It is often overlooked, and poses a diagnostic and management challenge. We report the case of an infant with recurrent neck infections despite appropriate treatment that was finally diagnosed as pyriform sinus fistula. [ABSTRACT FROM AUTHOR]