[Congenital fistula of the 4th pharyngeal pouch and cleft]

This is the first description of a fistula arising from both the fourth branchial cleft and the fourth pharyngeal pouch in a 62-year-old woman. This developmental anomaly ran from the piriform sinus to the skin of the left side of the neck. A small quantity of liquid was seen to flow from the external opening of the fistula during drinking or swallowing. Surgery revealed a tract inferior to the superior laryngeal nerve and lateral to the recurrent laryngeal nerve. This fistula penetrated the larynx in the region of the cricothyroid joint and ended in the piriform sinus. This patient had neither suffered infection of the fistula, nor had undergone a prior surgical procedure.