First branchial cleft anomaly extending to parapharyngeal space

Area of Science:

• Otolaryngology
• Head and Neck Surgery
• Congenital Anomalies

Background:

• First branchial cleft anomalies are rare congenital malformations, typically located near the ear canal and superficial to the facial nerve.
• Deeper extensions of these anomalies pose significant surgical challenges due to their proximity to critical structures like the facial nerve.

Observation:

• A 21-year-old student presented with a progressively enlarging infra-auricular cystic swelling.
• Magnetic resonance imaging revealed a first branchial cleft cyst with an unusual deep extension into the parapharyngeal space.

Findings:

• Surgical excision of the entire anomalous tract was successfully performed.
• The procedure involved a superficial parotidectomy via an open surgical approach.

Implications:

• This case underscores the importance of thorough pre-operative imaging to identify deep extensions of first branchial cleft anomalies.
• The successful management emphasizes the need for meticulous surgical planning and execution in rare, complex cases.
• Reviewing the literature aids in refining treatment strategies for these uncommon congenital malformations.