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Stridor as a presentation of fourth branchial pouch sinus

  • K Nathan (a1), Y Bajaj (a1) and C G Jephson (a1)



Anomalies of the fourth arch are the rarest of all the branchial anomalies. They arise as a result of failure of involution of the cleft during embryogenesis, and manifest clinically as sinuses, cysts or abscesses in the neck, commonly presenting in childhood.


This article describes a case of a neonate presenting with stridor which was secondary to a fourth branchial pouch sinus. The presentation, investigations, operative findings and treatment are discussed.


Microlaryngobronchoscopy was done to evaluate the stridor. A swelling in the posterolateral pharyngeal wall and a sinus opening in the pyriform fossa on the left side were identified. There were no external neck swellings. Magnetic resonance imaging confirmed a swelling in the expected region filled with air and fluid. After the diagnosis was confirmed, the swelling was aspirated and the fourth arch pouch treated. Microlaryngobronchoscopy was repeated six weeks later, showing complete resolution of the pharyngeal swelling. At this stage, the child had no airway symptoms and was feeding normally.


This is an interesting case of a fourth branchial cleft pouch presenting with stridor. The child was treated without any complications and recovered well.


Corresponding author

Address for correspondence: Mr Yogesh Bajaj, 2 Tall Trees, Leeds LS17 7WA, UK Fax: +44 (0)113 2663305 E-mail:


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1Neff, L, Kirse, D, Pranikoff, T. An unusual presentation of a fourth pharyngeal (branchial cleft) sinus. J Ped Surg 2009;44:626–9
2Sharma, HS, Razif, A, Hamzah, M, Dharap, AS, Mahbar, Z, Kamal, MZ et al. Fourth branchial pouch cyst: an unusual case of neonatal stridor. Int J Pediatr Otorhinolaryngol 1996;38:155–61
3Pereira, KD, Losh, GG, Dwight, O, Poole, MD. Management of anomalies of the third and fourth branchial pouches. Int J Pediatr Otorhinolaryngol 2004;68:4350
4Yang, C, Cohen, J, Everts, E, Smith, J, Caro, J, Andersen, P. Fourth branchial arch sinus: clinical presentation, diagnostic workup and surgical management. Laryngoscope 1999;109:442–6
5Nicollas, R, Ducroz, V, Garabedian, EN, Triglia, JM. Fourth branchial pouch anomalies: a study of six cases and review of the literature. Int J Pediatr Otorhinolaryngol 1998;44:510
6Ford, GR, Balakrishnan, A, Evans, JNG, Bailey, CM. Branchial cleft and pouch anomalies. J Laryngol Otol 1992;106:137–43
7Evans, SH, Marinello, M, Dodson, KM. Novel presentation of a fourth branchial cleft anomaly in a male infant. Am J Otolaryngol 2010;31:120–2
8Godin, MS, Kearns, DB, Pransky, SM, Seid, AB, Wilson, DB. Fourth branchial pouch sinus: principles of diagnosis and management. Laryngoscope 1990;100:174–8
9Shugar, HS, Healy, GB. The fourth branchial cleft anomaly. Head Neck Surg 1980;3:72–5
10Liberman, M, Kay, S, Emil, S, Flageole, H, Nguyen, LT, Tewfik, TL et al. Ten years of experience with third and fourth branchial remnants. J Pediatr Surg 2002;37:685–90
11Nicoucar, K, Giger, R, Harrison, GP, Jaecklin, T, Dulgerov, P. Management of congenital fourth branchial arch anomalies: a review and analysis of published cases. J Pediatr Surg 2009;44:1432–9
12Hamoir, M, Rombaux, P, Cornu, AS, Clapuyt, P. Congenital fistula of the fourth branchial pouch. Eur Arch Otorhinolaryngol 1998;255:322–4
13Leboulanger, N, Ruellan, K, Nevoux, J, Pezzettigotta, S, Denoyelle, F, Roger, G et al. Neonatal vs delayed onset fourth branchial pouch anomalies: therapeutic implications. Arch Otolaryngol Head Neck Surg 2010;136:885–90


Stridor as a presentation of fourth branchial pouch sinus

  • K Nathan (a1), Y Bajaj (a1) and C G Jephson (a1)


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