International Journal of Otorhinolaryngology and Head and Neck Surgery | August 2020 | Vol 6 | Issue 8 Page 1568 International Journal of Otorhinolaryngology and Head and Neck Surgery Mehta R et al. Int J Otorhinolaryngol Head Neck Surg. 2020 Aug;6(8):1568-1571 http://www.ijorl.com pISSN 2454-5929 | eISSN 2454-5937 Case Report First branchial cleft fistula: a case report Rupa Mehta 1 *, Ankit Mishra 1 , Nitin M. Nagarkar 1 , Vandita Singh 2 INTRODUCTION The term ‘branchial cyst’ was coined by Ascherson in in 1832. 1 First branchial cleft anomalies are a rare finding in head and neck, the incidence being around 1 million per year. 1-3 The occurrence of first branchial cleft anomalies usually varies from less than 8% to 21.4%. 1-3 They are distributed below external auditory canal, above the hyoid bone, anterior to sternocleidomastoid and posterior to submandibular triangle. 1 Main theories which describe the development of branchial cleft anomalies include incomplete obliteration of branchial mucosa, persistence of vestiges of pre-cervical sinus, origin from thyropharyngeal duct and origin from cystic lymph nodes. 1 In 1972, Work proposed a classification for first branchial cleft anomalies which states that type 1: anomalies superficial to facial nerve in close proximity to ear and type 2: lesion communicating with external auditory canal or tympanic membrane, mostly lying medial to facial nerve. 3 First branchial cleft cysts are frequently misdiagnosed as they are rare and pose unfamiliar clinical signs and symptoms. 4 Management of these includes early diagnosis, control of infection and complete excision with facial nerve preservation. 5 Here we present a case of first ABSTRACT First branchial cleft anomalies (BCA) are a rare finding in head and neck with incidence of nearly 1 million per year which are distributed below external auditory canal, above the hyoid bone, anterior to sternocleidomastoid and posterior to submandibular triangle. First branchial cleft cysts are frequently misdiagnosed as they are rare and pose unfamiliar clinical signs and symptoms. Here we are reporting a case of surgical management of 1st branchial cleft fistula in a 5 years old male child from AIIMS, Raipur, Chhattisgarh, India as it’s a rare entity. Child presented with discharge from right upper part of neck. There was a swelling in right upper lateral part of neck with an opening also in floor of right external auditory canal (EAC). Contrast enhanced computed tomography of neck showed a 4.8 cm long obliquely oriented fistulous tract opening at junction of middle and upper one third of sternocleidomastoid with opening in right EAC. Surgical excision of the fistulous tract was done with preservation of facial nerve. Histopathology examination confirmed the presence of fistula. Common clinical presentation of BCAs is pre- auricular swelling (24%), parotid swelling (36%) or cervical region swelling (41%). In our case, it was a fistulous opening that presented as discharging tract in upper neck. Management include early diagnosis, control of infection and complete excision with facial nerve preservation Surgical approach should be based on the clinical examination, imaging and clinical course; and there is a need to safely identify and preserve facial nerve in almost all cases. Keywords: Branchial cleft anomalies, Facial nerve, Branchial cleft fistula 1 Department of ENT and Head and Neck Surgery, 2 Department of Pathology, All India Institute of Medical Sciences Raipur, Chhattisgarh, India Received: 05 June 2020 Accepted: 09 July 2020 *Correspondence: Dr. Rupa Mehta, E-mail: rmehta0409@yahoo.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20203219