Fourth branchial pouch cyst: an unusual cause of neonatal stridor

Neonatal vs Delayed-Onset Fourth Branchial Pouch Anomalies

“…3,4,[6][7][8]18 In our experience, histologic examination of the resected specimen shows the presence of malpighian epithelium lining the tract along its path as well as the pouch, as described in the literature. 6,7,18 This contrasts with the histologic findings of cases presenting later in childhood in which such epithelium lining is restricted to the tract itself. [12][13][14] Five of our patients were in this neonatal category.…”

“…In the neonatal period, the presentation is usually as a cystic mass or an abscess, which may lead to dyspnea with stridor, dysphagia, and feeding difficulties. [6][7][8] The diagnostic workup of these lesions includes imaging. Ultrasonography can be used to identify the cervical collection, but to show the path of the tract either computed tomography (CT) or magnetic resonance imaging (MRI) is required 5,9 ( Figure 2).…”

Branchial anomalies in children

“…However due to the anatomical course of the tract, complete resection remains challenging [24,25]. Successful outcomes have been achieved more recently by endoscopic techniques, which is reliable, quick and simple with less post operative complications [26,27].…”

Fourth branchial complex anomalies: a case series

“…Anomalies in the embryogenesis of the fourth branchial apparatus were first reported in 1972 [3]; since, only sporadic case reports of fourth arch anomalies have been recorded, amounting to approximately 1-2% of all branchial anomalies [2,[25][26][27], and presenting generally as cysts or sinuses near (and at times within) the thyroid gland. The sinus tract--when present--originates within the pyriform fossa and follows a convoluted course exiting the larynx near the cricothyroid joint and coursing between the superior and recurrent laryngeal nerves [7].…”