Atypical first branchial cleft fistula: A case report

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Congenital Anomalies

Background:

• First branchial cleft anomalies (FBCA) are rare, with an incidence of approximately 1 in 100,000.
• Type I FBCA involve duplication of the external auditory canal, while type II presents with a fistula or cyst.
• Recurrent cervical infections can be indicative of underlying branchial cleft anomalies.

Observation:

• A 3-year-old girl presented with recurrent right lateral cervical infections and a purulent fistula near the mandibular angle.
• Clinical examination suggested a Type II first branchial cleft anomaly.
• The fistula tract followed an unusual path, extending under the facial nerve and parotid gland.

Findings:

• Surgical excision was performed via superficial parotidectomy, with meticulous identification and preservation of the facial nerve.
• The fistula tract was successfully dissected and ligated under the digastric muscle.
• Postoperative follow-up of 12 months showed no signs of recurrence or complications.

Implications:

• This case highlights the importance of precise surgical technique in managing complex first branchial cleft fistulas.
• Preserving the facial nerve during excision is crucial for preventing functional deficits.
• Effective surgical management ensures favorable outcomes and prevents recurrence of these rare congenital anomalies.