NA Aziz, FA Rahim, KB Noh, H Mohamad

Abstract

Branchial anomalies are the second most common head and neck lesions in children, following thyroglossal duct cysts. They typically manifest as lateral neck masses with potential infection, intermittently draining sinus, or fistula. Identifying the tract of a branchial fistula presents a challenge to surgeons. Preoperative imaging, such as computed tomography of the neck with fistulogram, and direct laryngoscope procedures are immensely helpful in locating the fistula. However, difficulties arise when the tract's location deviates from the standard anatomical development, as encountered in this case. Internal openings of branchial fistula are commonly found in the ear canal, tonsillar fossa, or pyriform fossa. We present a rare case of a branchial sinus with internal opening over the base of tongue that later develop into a pseudofistula, which, to the best of our knowledge, has not been reported in the existing literature.