A comprehensive approach to the diagnosis and surgical management of first branchial cleft anomaly: A case report and literature review

Background: First branchial cleft anomalies (FBCAs) are rare congenital malformations that result from incomplete obliteration of the first branchial cleft during embryogenesis. They often present with recurrent infections, swelling, and purulent drainage in the periauricular or parotid regions, leading to challenges in diagnosis and management.
Case Presentation: An 11-year-old girl with no significant personal or family medical history presented with recurrent right parotid region inflammation and intermittent purulent drainage. Initial management at an outside facility included incision and drainage, but the condition progressed to a persistent cutaneous fistula. Imaging studies, including high-resolution cervical ultrasonography and contrast-enhanced MRI, revealed a tubular fistulous tract extending from the right parotid region toward the skin opening, with surrounding chronic inflammation and a cystic formation along the tract. Surgical exploration confirmed the tract’s deep relationship with the facial nerve. The patient underwent a superficial parotidectomy, with successful facial nerve preservation and no recurrence at 12 months of follow-up.
Conclusion: FBCAs, though rare, require early diagnosis and timely surgical intervention to prevent recurrent infections and nerve damage. Advanced imaging modalities such as MRI are essential for accurate preoperative assessment and surgical planning. Complete excision with facial nerve preservation is the gold standard for treatment, offering excellent long-term outcomes when managed in specialized centers.