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The fourth branchial pouch sinus is a developmental anomaly which most freqently manifests itself by recurrent episodes of neck abscess or acute suppurative thyroiditis. The most common developmental anomalies of the branchial apparatus are second cleft remnant, which constitute almost 95% of all anomalies. The remaining 5% are comprised almost exclusively of first and third arch remnants. So the fourth arch remnants are exceedingly rare. A high index of suspicion, combined with barium swallow pharyngogram and computed tomography scan can aid in diagnosis. Complete excision of the entire epithelial tract combined with ipsilateral thyroid lobectomy remains the mainstay of treatment. Authors experienced a case of lateral neck mass which was pathologically presumed to be the fourth branchial pouch sinus. We report this case with the related literature. (Korean J Otolaryngol 2003;46:246-9)