A Type-II First Branchial Cleft Anomaly Presenting as a Post-Auricular Salivary Fistula: A Rare Presentation
A 12-year-old female presented to Otolaryngology Department of our hospital with a history of intermittent watery discharge at the time of meals from an opening behind her right ear for last 3 years. It began with a swelling behind the ear with intermittent pus discharge from the right ear. After some days, the post-auricular swelling spontaneously ruptured with pus discharge. The same site was then marked by a persistent small opening in the skin which discharged clear fluid intermittently, more at the time of meals. The ear discharge stopped, once the discharge began from the post-auricular region. There was no history of purulent discharge from the opening. She denied any history of trauma, hearing loss or any other swelling. On examination, there was a small cutaneous opening near mastoid tip behind the ear lobule, which discharged clear fluid (saliva) on pressing the parotid gland []. External auditory canal and tympanic membrane were normal. Audiological tests were normal.\nComputed tomography (CT) sialography carried out after cannulation of right Stensen's duct and injection of radio-opaque contrast revealed a fistulous tract connecting the sub segmental duct of the parotid gland extending along the pre-tragus region in subcutaneous plane up to mastoid tip after passing inferior to external auditory canal [Figure and ].\nThe patient underwent superficial parotidectomy through an S-shaped incision with excision of the tract. The tract was superficial to the branches of the facial nerve and ended into the parotid gland []. The facial nerve branches were completely visualized and preserved. Histopathology revealed sinus tract comprising of ectodermal components and acini of the parotid gland [].