Abnormalities of the third branchial arch are less common than those of the second arch and usually present with left thyroid lobe inflammation. This paper describes 15 cases of pyriform sinus fistulae of third branchial arch origin usually presenting as recurrent thyroid abscess on the left side.

A retrospective review of 15 cases of third arch fistulae managed 2000 and 2008, diagnosed based on histopathology and radiological evidence of a fistulous tract, and treated with fistulectomy with left hemithyroidectomy.

All patients (six boys and nine girls, aged three to 15 years) presented with recurrent low neck inflammation. Pre-operative ultrasound, computed tomography fistulography and barium swallow demonstrated a third arch fistulous tract, left-sided in all cases. The fistula was detected intra-operatively and pathologically in all cases. Surgery (successful in all cases) emphasised complete recurrent laryngeal nerve and ipsilateral pyriform sinus exposure, to facilitate tract excision, with left hemithyroidectomy. There was no recurrence over three to five years' follow up.

Paediatric recurrent low neck inflammatory episodes, due to thyroidal abscess, especially left-sided, should raise suspicion of pyriform sinus fistulae.

We present a rare case of an unusual presentation of a pyriform sinus haemangioma in a normally healthy, Caucasian woman, including our management and a review of the literature.

A 44-year-old woman presented complaining of bringing up fresh blood whilst brushing her teeth, dysphonia, food sticking in her throat, and epigastric pain for the preceding 12 months, accompanied by a 17.5 kg weight loss. She underwent pre-operative computed tomography and subsequent complete excision of a pyriform sinus haemangioma using CO2 laser.

Haemangiomas are congenital vascular malformations and can affect any part of the body. They are not prevalent in adults and are rarely found in the pyriform sinus. Their common presenting symptoms and management have been previously documented; however, the presented case is unusual in both its presentation and management.

We report an extremely rare case of a complete congenital third branchial arch fistula in a nine-year-old boy.

A case report and a review of the English literature concerning third branchial arch fistula of congenital origin are presented.

A nine-year-old boy presented with a history of a small opening in the middle third of the anterior neck since birth, with recurrent surrounding swelling. There was no history of surgical drainage or spontaneous rupture. Computed tomography with contrast injection into the external cervical opening revealed a patent tract from the neck skin to the base of the pyriform sinus. Complete excision of the tract up to the pyriform sinus with left hemithyroidectomy was performed. Follow up at 22 months showed no recurrence.

To our knowledge, this case represents a very rare occurrence of the congenital variety of complete third branchial arch fistula at an unusual site. This case indicates that third branchial arch fistula can be complete, and may present in the anterior neck, an unusual site. In such cases, computed tomography fistulography and injection of dye into the pyriform sinus enables intra-operative delineation of the tract.