Recurrent Unexplained Neck Abscess Due to 4th Branchial Anomaly

Branchial arch anomalies commonly manifest as cyst, sinus, or fistulous opening in the neck. They commonly arise from the 2nd arch and rarely from other arches. Among them, anomalies from the 4th arch are very rare and they usually present as recurrent abscess/swelling in the lower part of the neck. Also, history of repeated incision and drainage (I&D) is often present. In 4th arch anomaly, the tract passes from the skin into the thyroid lobe and then opens internally into the apex of the pyriform sinus. Hence, hemithyroidectomy is required for complete excision of the tract. Here, we describe four cases of recurrent neck abscess, which were evaluated and treated in our tertiary care hospital in India.