Coexisting thyroglossal duct cyst and branchial cleft anomaly has been reported only one case before. This is the second reported case of coexisting thyroglossal duct cyst and second branchial cleft fistula in an adult. The definitive treatment of thyroglossal duct cysts and branchial cleft anomalies is complete surgical excision of the entire tract. Coexisting thyroglossal duct cysts and branchial cleft fistula should be considered in the differential diagnosis of neck lesions, even in an adult.