Atypical first branchial cleft fistula: A case report

Abstract

Highlights First branchial cleft fistula are rare and can be in form of cyst or fistula. Clinically, they may masquerade as parotid tumours or as otitis with ear drainage. Its management is surgical excision keeping the tract cyst of the fistula intact. Superficial parotidectomy with facial nerve dissection is the key to complete excision of the cleft fistula with preservation of the facial nerve.

Horn-shaped Symmetric Nodules on the Earlobes: An Unusual Presentation of First Branchial Cleft Anomaly

“…A radiologic study, such as computed tomography, may be helpful in determining the location or internal range, but it is not necessary in all cases. The entire tract of a first BCA must be removed during surgical resection because previous reports describe cases in which the fistula formed inside 10,11…”

Postauricular Cyst in a 15-Year-Old Girl

“…1 First BCA is rare and comprises 1% to 8% of all BCAs. 2 Although typical imaging features of BCA have been reported, imaging findings can be atypical under specific pathologic conditions, including secondary infection, hemorrhage, or malignant transformation. 1 Duplication or failure of obliteration of the embryologic tract is thought to be the cause of BCA.…”

“…2 Branchial cleft anomaly commonly affects female patients and the left side of the head and neck. 2,3 First BCA can present as either a cyst, sinus, or fistula in the Poncet triangle, which has its apex at the EAC and base between the chin and midpoint of the hyoid bone, with chronic or recurrent upper neck infections. 3 First BCA was divided into types 1 and 2 by the Work classification system in 1972.…”

“…3 First BCA was divided into types 1 and 2 by the Work classification system in 1972. [2][3][4][5] Type 1 anomaly is usually discovered in very young children as a thin-walled, soft mass located medially, inferiorly, or posteriorly to the pinna and superficial to the facial nerve. 2,4 Type 2 anomaly is usually discovered at a later age as a fistulous opening within the Poncet triangle.…”

“…[2][3][4][5] Type 1 anomaly is usually discovered in very young children as a thin-walled, soft mass located medially, inferiorly, or posteriorly to the pinna and superficial to the facial nerve. 2,4 Type 2 anomaly is usually discovered at a later age as a fistulous opening within the Poncet triangle. 4 For BCA, MRI is a useful diagnostic modality to identify the extent of the lesion, the relationship with the facial nerve, and the risk of facial nerve damage for operative planning.…”