PMC3420790_01
A sinus tract is seen originating from the left side of the pyriform sinus, while a cholangiocath was used to cannulate the tract prior to dissection.
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fig1
In the operating room, direct laryngoscopy revealed a sinus tract originating from the left side of the pyriform sinus apex (Figure 1); a cholangiocath was used to cannulate the tract and surgical exploration of the neck revealed the tract to pass through the hypopharyngeal wall just posterior to the right laryngeal nerve entrance into the larynx and beneath the superior laryngeal nerve, consistent with a fourth branchial anomaly.
PMC3420790_02
This fistula presented to our clinic as a draining neck wound on the anterior portion of the patient's left sternocleidomastoid muscle.
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fig2
He also had a draining neck wound on the anterior portion of his left sternocleidomastoid muscle (Figure 2).
During dissection, the fistulous tract was seen exiting the pharynx inferior to the superior laryngeal nerve during exploration, while showing a complete connection with the neck skin.
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fig3
The fistulous tract was found to exit the pharynx inferior to the superior laryngeal nerve during exploration, consistent with an anomaly of the fourth branchial pouch (Figure 3).