Congenital cysts, sinuses and fistulas of the head and neck are anomalies that may be encountered in pediatric life. They represent abnormal development of the brachial apparatus or inclusion of the ectoderm at any site of the lines of fusion of the face. In the head, preauricular, salivary and median nasal fistulas as well as dermoid cysts and Van der Woude syndrome are examples. In the neck, median thyroglossal cyst and fistula, and lateral brachial cyst and fistula are well-known congenital anomalies. Proper diagnosis of these malformations is essential to decide the line of treatment. Standard and modified surgical procedures are adopted for excision and repair of these anomalies with the possibility of incidence of complications, recurrence and malignancy.