The endoscopic approach to a fourth branchial pouch sinus presenting in an adult.

Fourth branchial complex anomalies are rare and typically present in neonates or adolescents. Surgical management via open excision is the traditional approach to prevent recurrence. However, endoscopic sinus cauterization has recently been reported as a less invasive alternative. The current case report represents the first published account of a fourth branchial pouch presenting in an adult patient effectively managed through endoscopic excision. We compare this method to open excision and endoscopic ablative techniques.