A 37-year-old Saudi female patient presented with an unusual case of a third/fourth branchial cleft cyst and acute suppurative thyroiditis. She had been experiencing fever, dysphagia, and neck pain for 5 days, unrelieved by antibiotics. An initial CT scan showed a parapharyngeal abscess, which was further evaluated to reveal a collection mainly within the parapharyngeal and retropharyngeal spaces. Laryngoscopy indicated a large paraglottic collection causing vocal fold immobility. The surgical intervention involved intraoral drainage and cauterization of the identified branchial cleft sinus. Postoperative evaluation was completed, and the patient was discharged. All antibiotics were administered, resulting in excellent clinical improvement. It is important to consider branchial cleft anomalies as differential diagnoses for acute neck infections, and it is essential to involve multiple specialists in determining the diagnosis and treatment plan.
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