First branchial cleft anomalies (FBCA) represent a small subset of congenital malformations in neck. Prime objective of this study is to share our experience with FBCA, emphasize its relevance in otolaryngology and deal with its pediatric perspective. Embryology, pathologic anatomy and varied spectra of clinical presentations of FBCA are discussed. Along with this we have illustrated three different cases; all of them were of pediatric age group and were misdiagnosed by their treating specialists elsewhere. In this article we have also laid special emphasis on its pediatric considerations. FBCA are mostly misdiagnosed due to their unfamiliar clinical signs and symptoms. Swellings may masquerade as other neck masses. Majority of patients give a history of previous incision and drainage. While dealing with pediatric patients the important factors to be kept in mind are the age of child, superficial course of facial nerve, any associated agenesis of parotid gland. Alteration in surgical technique may be required in children. A thorough medical examination with high index of clinical suspicion should be kept in mind while dealing with such anomalies. Owing to their complex presentation and close relation with facial nerve they are challenging lesions for surgeons.

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Introduction  Plexiform neurofibroma is a benign tumor of peripheral nerves arising from a proliferation of all neural elements. Clinically, it presents as a subcutaneous mass which feels like a "bag of worms". Case Report  A 23-years-old male with a swelling over left side of the face large enough to involve whole one side of the face. There was tenderness and the swelling had a very peculiar consistency, soft in most of the areas with few firm nodular areas. Operative procedure: surgery was done in two stages. Initially subtotal excision was done and 3 months later re-explored to excise the recurrent disease. Complete excision was not possible. Discussion Plexiform neurofibroma (PNF) occurs due to overgrowth of neural tissue in the subcutaneous region. Surgical management remains the mainstay of treatment but functional disturbances are almost inevitable while resecting tumors involving the head and neck region. Resection and de bulking of invasive PNF is however associated with a high rate of recurrence. One of the limiting factors is vascularity of these lesions and their abnormal propensity to bleed. Conclusion  Although benign, plexiform neurofibromas can cause pain, disfigurement and functional changes and more importantly, may turn malignant. Surgery should be attempted considering psychological benefits.

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