Fig. 4
From: Surgical treatment of fourth branchial apparatus anomalies: a case series study

Right-sided fourth branchial pouch sinus. a Tiny amount of right-sided barium outflow from pyriform sinus can be seen on X-ray film (blue arrow). b Right-sided massive cervical inflammation of the same patient. c Pre-operative cervical photo shows no cervical cutaneous orifice. d Step ladder incision for this patient, with drainage tube in surgical field