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Case Reports
. 2018 Jan 30:2018:4215802.
doi: 10.1155/2018/4215802. eCollection 2018.

A Case of First Branchial Cleft Fistula Presenting with an External Opening on the Root of the Helical Crus

Sung Il Cho  1
Affiliations
Case Reports

A Case of First Branchial Cleft Fistula Presenting with an External Opening on the Root of the Helical Crus

Sung Il Cho. Case Rep Med. .

Abstract

Background: First branchial cleft anomalies (FBCA) are rare clinical entities of the head and neck. Typically, the tract of the FBCA begins in the external auditory canal and ends in the postauricular or submandibular region.

Case presentation: We present a case of a 23-year-old man who had a first branchial cleft fistula with atypical opening on the root of the helical crus. Complete excision of the tract, including the cuff of surrounding cartilage, was performed. Histopathology revealed a fistular tract lined with squamous epithelium. To our knowledge, this is the first case to be reported of type I FBCA with an opening on the root of the helical crus. The low incidence and varied presentation often result in misdiagnosis and inappropriate treatment.

Conclusions: In the patients with FBCA, careful recognition of atypical variants is essential for complete excision.

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Figures

Figure 1
Figure 1
The opening of the fistula tract is seen on the root of the helical crus (a). A lower opening is visible in the postauricular crease (b).
Figure 2
Figure 2
A CT scan with contrast shows a left rim-enhancing cyst in the postauricular crease.
Figure 3
Figure 3
Surgical findings of the fistula tract. The tract and the opening in the postauricular crease (arrow) were excised (a). The fistula tract after total removal (b).
Figure 4
Figure 4
The fistula was lined with squamous epithelium, with features suggestive of a branchial cleft fistula (×100, hematoxylin and eosin stain).
See this image and copyright information in PMC

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