An unusual otoscopic finding associated with a type II first branchial cleft anomaly

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Medical Genetics

Background:

• Branchial cleft anomalies are congenital malformations that can present with varied clinical manifestations.
• First branchial cleft anomalies, often presenting as cysts or fistulas, require careful diagnosis and management.
• The Work classification system is commonly used but may not encompass all presentations.

Observation:

• A seven-year-old girl presented with a suspected type II first branchial cleft cyst.
• Initial surgery for parotidectomy and tract excision was followed by recurrent pre-auricular swelling.
• A second, previously undetected, duplication anomaly of the external auditory canal was identified.

Findings:

• Otomicroscopy revealed a unique finding: a fibrous band connecting the external auditory canal wall to the tympanic membrane at the umbo.
• This fibrous band was associated with the branchial cleft anomaly, suggesting a complex developmental origin.
• The case illustrates a rare presentation of a first branchial cleft anomaly with an unusual otoscopic finding.

Implications:

• Unusual otoscopic findings can serve as crucial diagnostic indicators for branchial cleft anomalies.
• This case underscores the limitations of existing classification systems for branchial cleft lesions.
• Accurate diagnosis and surgical management are essential for favorable outcomes in pediatric patients with complex congenital anomalies.