[Anomalies of the first branchial cleft]

These are cysts and fistulae which closely adherent to the external auditory canal and drain through the high lateral cervical suprahyoid site. Misdiagnosis is common with these lesions and inadequate removal leads to surgical failure. A review of the embryology of this region is necessary since we intend to explain the clinical aspects and the variable relationship to the facial nerve. Eight cases are described and the literature pertaining to first branchial cleft syndrome is reviewed. Diagnostic and management problems will be discussed. A full exposure of the parotid gland and facial nerve is essential to complete removal and facial nerve preservation.