A Case of Rare Fourth Branchial Arch Anomaly: Presentation and Surgical Management

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.