Congenital cutaneous fistula at the sternoclavicular joint - Not a dermoid fistula but the remnant of the fourth branchial (pharyngeal) cleft ?

Michinobu Ohno, Yutaka Kanamori, Kotaro Tomonaga, Tatsuya Yamashita, Misato Migita, Toshiko Takezoe, Toshihiko Watanabe, Yasushi Fuchimoto, Kentaro Matsuoka

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)


Objectives: A fourth branchial pouch remnant is well known as a pyriform sinus fistula. However, there has been no report of a fistula composed of the complete remnant of the fourth branchial apparatus. We experienced patients with a congenital lower neck cutaneous fistula which was thought to be the skin-side remnant of the fourth branchial cleft. Materials and methods: Seven children were referred to our hospital from 2009 to 2015 for the treatment of a cutaneous fistula situated near the sternoclavicular joint. All of them were surgically resected and their pathological characteristics were examined. Clinical charts were retrospectively reviewed. Results: In six cases, the left side was affected. All cutaneous fistulas had a small skin orifice near the sternoclavicular joint and they were situated at the anterior edge of the sternocleidomastoid muscle. Abscess formation was seen in four cases. Surgical resection was performed at the age of 6 months to 9 years. These fistulas ran deep into the subcutaneous tissue and had a blind end. Pathological examination showed that the epithelial layer was mainly composed of a stratified squamous epithelium. In two cases the epithelium was composed of ciliated columnar epithelium. Recurrence has not been observed in any of the cases. Conclusion: The seven cases had a common clinical feature and were a definite clinical entity. Judging from the characteristics of our cases and the previous literature, we concluded that this lower neck cutaneous fistula was most likely a congenital skin-side remnant of the fourth branchial cleft.

Original languageEnglish
Pages (from-to)2120-2123
Number of pages4
JournalInternational Journal of Pediatric Otorhinolaryngology
Issue number12
Publication statusPublished - 2015 Dec 1
Externally publishedYes


  • Cutaneous fistula
  • Fourth branchial cleft
  • Pyriform sinus fistula

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Otorhinolaryngology


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