Related Experiment Video
Updated: Jul 5, 2026

Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy
Published on: October 24, 2025
Fourth branchial cleft sinus: relationship to superior and recurrent laryngeal nerves
Belinda A Mantle1, Todd D Otteson, David H Chi
1Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA 15213-2583, USA.
Objectives:
1) Demonstrate the surgical anatomy of a fourth branchial cleft sinus relative to the superior and recurrent laryngeal nerves. 2) Review the diagnosis and management of a fourth branchial cleft sinus.
Design:
Case Study.
Setting:
Tertiary Children's Hospital.
Patient:
Three year old female who presented with a fever and painful right neck mass. CT scan demonstrated a right neck abscess containing air adjacent to the thyroid.
Intervention:
Two months after initial drainage, the patient underwent enbloc excision of the sinus including the thyroid lobe with closure of the piriform sinus defect.
Main Outcome Measure:
Intraoperative photo documentation of the anatomic relationship between the fourth branchial sinus and surrounding neural structures.
Results:
The sinus tract was shown to terminate in the piriform sinus inferior to the superior laryngeal nerve.
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