Surgical excision of first cleft branchial fistulae

Three patients were studied who had fistulae in the neck derived from the first branchial cleft. Evidence is presented to show that although these fistulae usually pass superficial to the facial nerve they may also pass deep to one or both main divisions of the nerve. We conclude that a formal superficial conservative parotidectomy with full exposure of the facial nerve is the safest operative course when excising these fistulae.