Fourth branchial cleft cyst in an infant. Case report and modified surgical approach

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Fourth branchial cleft anomalies are rare anomalies with a wide variety of clinical symptomatology and different surgical approaches. These approaches has been described with variable success and rates of complications with no standard surgical approach described. In this case report we present an infant with left sided fourth branchial cleft cyst treated with a modified surgical approach combining endoscopic identification of the inner opening and insertion of a fine guidewire followed by surgical excision and ligation of the fistula tract.