Atypical first branchial cleft fistula: a case report
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First branchial cleft anomalies (FBCA) are rare. They have an estimated incidence of 1 in 100,000. Type I are those that embryologically duplicate the membrane (cutaneous) external auditory canal. The aim of this case is to describe an unusual path of a type II first branchial cleft fistula tract in a 3 years old child and its surgical management.

This case is about a 3 years-old girl with no relevant medical history who presented to the Ear Nose Throat (ENT) consultation for recurrent right lateral cervical infection. At the age of one year, the first infectious episode occurred in the form of an abscess of the soft tissues under angulo-mandibular without the notion of otorrhea. The patient received local treatment with incision and drainage of the abscess and general antibiotic therapy without improvement. The course was characterized by fistulization of the skin and resulting from pus. Clinical examination found an unsightly scar attached to an orifice giving pus located near the right mandibular angle suggesting type II first branchial cleft anomaly, no orifice at the level of the external auditory canal, and the tympanic membrane was normal in appearance. The patient underwent an ultrasound to obtain a diagnosis.

Surgical excision was performed under general anesthesia by a senior neck surgeon by an antegrade super-cial parotidectomy approach, the facial nerve was identified and preserved. The fistula cord was dissected and followed, it went under the facial nerve and the parotid gland to end under the digastric muscle where we tied it up. The postoperative check-up did not show any complications. The follow-up period was 12 months; the clinical examination did not find any sign of recurrence.