Third and Fourth Branchial Cleft Sinus Presenting with Neck Discharge - A Rare Case Report

Third and fourth branchial cleft anomalies are rare congenital defects affecting children. They arise due to the incomplete obliteration of branchial clefts during embryogenesis. Nearly 90% of the third or fourth branchial pouch sinus tracts are situated on the left side of the neck. It is difficult to differentiate the third and fourth branchial cleft anomalies on radiological imaging due to their close proximity; hence, they may be treated as the same disease. In this report, we describe the case of a 17-year-old male patient with a persistent branchial cleft sinus tract and its clinical presentation, diagnostic evaluation, and surgical management and discuss the preoperative evaluation, pitfalls in diagnosis, and surgical management, including strategies for the management of third or fourth branchial cleft sinus.