ABSTRACT
The preauricular sinus is a congenital sinus whose opening is situated on the anterior aspect of the helix of the pinna. Cysts and sinuses of the third and fourth branchial pouch are clinically similar because of their common origin in the piriform fossa and presentation as a neck or thyroid abscess. Exploration of the neck with excision of the entire tract to the level of the piriform sinus is necessary to prevent recurrence. The operation to excise a second branchial cleft sinus begins with an elliptical transverse incision at the sinus opening, and cephalad dissection of the tract to its furthest extent, generally at the level of the tonsillar pillar. The aim of surgery is to remove the entire thyroglossal duct, including the central part of the body of the hyoid bone, to the level of the foramen cecum. Complete excision is essential to prevent recurrence and eliminate the risk of malignant degeneration.
