FOURTH BRANCHIAL ANOMALY: The theoretic course of a fourth branchial anomaly is similar to a third except it passes under the superior laryngeal nerve but over the recurrent laryngeal and hypoglossal nerves. It then dips back into the chest to pass around the aortic arch on the left and the subclavian artery on the right.
A suprahyoid neck dissection was done under general anaesthesia with preservation of marginal mandibular, lingual and hypoglossal nerves. No cervical lymphadenopathy was detected during dissection as well.
The patient was advised that sacrifice of the lingual arteries and hypoglossal nerves bilaterally might be required in order to achieve complete tumor resection, and consent was obtained for possible total glossectomy.