Clinical manifestations, diagnosis, and management of first branchial cleft fistula: Case series and review of the literature

The first branchial cleft (FBC) is an extremely rare occurrence, manifesting as cysts, sinuses or fistula. Among all branchial anomalies, FBC represents 8–10 % of branchial clefts. It accounts for about 17 % of all cervical masses in childhood. FBC can be caused by inadequate removal or closure of the ectoderm. The location of the fistula can be adequately determined by magnetic resonance imaging (MRI). We report three cases from the first branchial cleft fistula (FBCF) in our ENT Department with a good response to surgical treatment. Patients had an average of 24 months of follow-up. The aim of our study is to study the clinical manifestations, the diagnosis and the surgical management of the FBCF. An in-depth knowledge of the embryology of the neck and face will ensure early diagnosis and complete surgical resection of FBCFs, which will minimize the risk of severe complications including facial paralysis. FBC is rare and may present as a cyst or fistula. It is managed by surgical excision, leaving the tract cyst of the fistula intact with preservation of the facial nerve.