case_images: PMC3420790_01
case_images: A sinus tract is seen originating from the left side of the pyriform sinus, while a cholangiocath was used to cannulate the tract prior to dissection.
case_images: CRIM.OTOLARYNGOLOGY2011-958652.001.jpg
case_images: PMC3420790_01_CRIM.OTOLARYNGOLOGY2011-958652.001.jpg
case_images: fig1
case_images: In the operating room, direct laryngoscopy revealed a sinus tract originating from the left side of the pyriform sinus apex (Figure 1); a cholangiocath was used to cannulate the tract and surgical exploration of the neck revealed the tract to pass through the hypopharyngeal wall just posterior to the right laryngeal nerve entrance into the larynx and beneath the superior laryngeal nerve, consistent with a fourth branchial anomaly.
case_images: PMC3420790_02
case_images: This fistula presented to our clinic as a draining neck wound on the anterior portion of the patient's left sternocleidomastoid muscle.
case_images: CRIM.OTOLARYNGOLOGY2011-958652.002.jpg
case_images: PMC3420790_02_CRIM.OTOLARYNGOLOGY2011-958652.002.jpg
case_images: fig2
case_images: He also had a draining neck wound on the anterior portion of his left sternocleidomastoid muscle (Figure 2).
case_images: During dissection, the fistulous tract was seen exiting the pharynx inferior to the superior laryngeal nerve during exploration, while showing a complete connection with the neck skin.
case_images: CRIM.OTOLARYNGOLOGY2011-958652.003.jpg
case_images: PMC3420790_02_CRIM.OTOLARYNGOLOGY2011-958652.003.jpg
case_images: fig3
case_images: The fistulous tract was found to exit the pharynx inferior to the superior laryngeal nerve during exploration, consistent with an anomaly of the fourth branchial pouch (Figure 3).