Isolated First Branchial Cleft Anomalies of the External Auditory Canal

Area of Science:

• Otolaryngology
• Developmental Biology
• Surgical Pathology

Background:

• Branchial cleft anomalies are congenital malformations arising from pharyngeal pouch development.
• First branchial cleft anomalies present diagnostic challenges, often requiring imaging and histology for confirmation.
• Surgical excision is typically indicated due to risks of infection and malignancy.

Observation:

• An 82-year-old woman presented with hearing loss and recurrent ear infections, symptoms localized to the external auditory canal.
• Imaging studies, including CT and MRI, were crucial for surgical planning.
• The patient had no reported facial nerve involvement.

Findings:

• Surgical intervention involved canaloplasty and Thiersch grafting.
• Histopathological examination revealed a cystic lesion with cylindrical epithelium, atypical for the external auditory canal.
• The findings were consistent with first branchial arch malformative residues.

Implications:

• This represents a unique presentation of a first branchial cleft anomaly exclusively involving the external auditory canal in an adult.
• The atypical presentation underscores the importance of considering rare congenital conditions in the differential diagnosis of external auditory canal cysts.
• Complete surgical removal remains the definitive treatment for such anomalies.