It is commonly believed that the branchial anomalies are remnants of the branchial apparatus. Third and fourth branchial pouch anomaly is an extremely rare disease involving the branchial apparatus. Virtually mostly reported cases have been on the left side and has been identified in recurrent suppurative thyroiditis, retropharyngeal abscess and repeated episodes of cellulitis, neck swelling, lateral neck fistula. Recently the authors have experienced a case of left piriform sinus fistula accompanied with left suppurative thyroiditis, presumably of fourth branchial origin in a 50-years old male patients, which was successfully treated with coagulation, and so report this case with summary of branchial anomaly by the some review of the literatures.