First branchial cleft fistula: a difficult challenge.

irst branchial cleft anomalies account for 8--10%1,2 of all ranchial cleft defects, representing approximately 17% of ll pediatric cervical masses. The low incidence and the arious clinical presentations of these congenital malformaions of the branchial apparatus make the diagnosis difficult ven for the experimented otolaryngologist. Depending on he type of the anomaly (fistula, sinus or cyst), the fistulous ract can be located medial or lateral to the facial nerve. T scans provide useful information on the location of the stulous tract. We report a rare case of type II first branchial cleft fistula resenting as a tract with 2 openings -a cervical opening in he left submandibular region and a small fistulous opening t the floor of the cartilaginous portion of the left exteral auditory canal (EAC). Treatment consisted in complete xcision of the fistulous tract and superficial parotidectomy ith preservation of the facial nerve.