Fourth branchial pouch or cleft anomalies

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Fourth branchial cleft and pouch anomalies are rare but clinically important entities that require a high index of suspicion. A missed diagnosis can prolong patient morbidity resulting in incorrect treatment and probable recurrence. These anomalies are secondary to errors in embryogenesis from incomplete involution of the fourth branchial cleft or pouch, resulting in the formation of a cyst, sinus, or fistula. They commonly present as a recurrent lateral neck swelling in the pediatric population. Surgery is the mainstay of treatment.