In A PREVIOUS communication1 Dr. Stahl and I discussed branchial cleft anomalies from a clinical and embryological standpoint and made an extensive review of the available literature. No cases similar to the present one were found. While our knowledge of the embryology of this area is fragmentary and the evidence confusing, it would seem possible to ascribe the present anomaly, with its close relationship to the hypopharynx, to the third branchial cleft, or, more exactly, its internal component, the third pharyngeal pouch. Report of Case A Negro patient, aged 32, was first seen on Jan. 26, 1955, complaining of a painful swelling of the right side of the neck for two days. There had been great difficulty and pain in swallowing fluids as well as solid food for one day. Talking was also painful. This was the fourth attack of this type and the severest. The first episode of