Right-Sided Type IV Branchial Cleft Anomaly in a Seven-Year-Old Boy: A Case Report.

Type IV branchial cleft anomalies, which can present as a cyst, sinus, or fistula, are the rarest type of branchial cleft anomalies. Although they can present at any age, they typically present during childhood with a history of frequent neck abscesses. Type IV branchial cleft anomalies usually occur on the left side near the medial lower border of the sternocleidomastoid (SCM) muscle and can extend to the pyriform sinus in the larynx. They can also present with thyroid involvement. Imaging with ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), sinogram, and direct laryngoscopy (DL) can aid in diagnosis. Sinus tracts, while not always present, may develop as a complication. Treatment is with surgical excision of the tract and debridement of the abscess in the setting of acute infection. Here, we present a rare case of right-sided type IV branchial cleft cyst in a seven-year-old boy who was treated primarily with ablation using Bugbee cauterization and drainage, avoiding the need for any further surgical intervention, including further drainage or thyroidectomy.