Imaging description

Repeated otorrhea and recurrent parotid swelling in infancy and childhood should prompt further cross-sectional imaging. One of the most important causes for this condition is infected first branchial cleft cyst. The branchial anomalies occur as a result of persistence of vestigial remnants of first branchial apparatus [1,2]. They are rare lesions. The first branchial cleft cyst accounts for only 8–10% of branchial cleft anomalies. They are divided into two major types [3]. Type I first branchial cleft cyst occurs in the preauricular area and lies parallel to the external artery canal (EAC) and lateral to the facial nerve (Fig. 76.1). Type II first branchial cysts are located posterior or inferior to the angle of the mandible and are intimately associated with the parotid gland and facial nerve (Fig. 76.2). There is generally presence of a sinus track reaching up to the junction of the membranous and bony portion of the external auditory canal and in close proximity to the facial nerve [2,3].

Importance

The first branchial cleft anomalies are relatively rare. A high index of suspicion in patients with a cyst or sinus around EAC and within the parotid gland is important. Incision and drainage of suppurative fluid collection can result in repeated recurrence. Definitive total surgical excision, achieved with a superficial parotidectomy approach with facial nerve identification and facial nerve exposure, results in excellent outcomes [4].