Malformations of the first branchial cleft: duplication of the external auditory canal

Abstract

Objective: Malformations of the first branchial cleft are uncommon and only sporadic reported in the literature. The may be present as a swelling or inflammatory opening on the neck, blind cysts or fistula associated with the external auditory canal. In this retrospective study, clinical features, diagnostic and therapeutic pitfalls are described in nine pediatric cases.

Patients and results: Between 1998 and 2002, duplication of the external auditory canal were diagnosed in nine patients aged from 7 months to 14 years. Three infants had cysts in the external ear canal; one had a sinus on the anteroinferior canal wall. One girl had two canals divided by skin and both were blind ended. Three children had clinically swelling or abscess formation with persistent drainage below the earlobe or on the neck and one girl had swelling behind the auricle. All patients were treated surgically.

Conclusion: The first branchial cleft malformation may be unrecognized or may be mistaken for tumors or other inflammatory lesions in the periauricular region. Surgical treatment might then be inadequate leading to recurrence or secondary infection. The distinct clinical features, which can be derived from embryologic development, usually lead to the correct diagnosis and favorable surgical treatment.