TYPE FOUR BRANCHIAL FISTULA: DIAGNOSIS AND MANAGEMENT: A RARE CASE REPORT

Branchial cleft fistulae are rare congenital abnormalities that arise from the abnormal persistence of branchial apparatus remnants. Fourth branchial cleft fistulae pass deep to second arch structures and over third arch structures, in a direction extending from the anterior border of sternocleidomastoid (SCM) muscle to the upper pole of the ipsilateral pyriform fossa. Because of this anatomical route, these long tubular structures are intimately associated with major neuro-vascular structures in the neck. We present the clinical presentation and surgical management of a fourth branchial cleft fistula, in a 23-year-old male. Preoperative CECT fistulogram of the neck clearly demonstrated the fistula. Patient was managed using combined stepladder transcervical and intra