Fourth branchial pouch anomaly is an extremely rare condition involving the branchial apparatus, with only about 30 cases having been reported in the last 20 years. Mostly it occurs on the left side and typically presents with repeated episodes of neck swelling, lateral neck fistula, recurrent thyroiditis, or repeated bouts of retropharyngeal abscess. Recently the authors have experienced a case of right pyriform sinus fistula, presumably of fourth branchial origin, which was successfully treated with complete excision. So we report this case with summary of branchial anomaly by the review of literatures.