title: First branchial cleft anomalies have relevance in otology and more.
abstract: BACKGROUND
  First branchial cleft anomalies account for less than 8% of all branchial abnormalities. Their rarity and diverse presentations have frequently led to misdiagnosis and inappropriate treatment. In a trend towards specialisation/subspecialisation, first branchial cleft duplication anomalies, with their varied clinical manifestations, may possibly present to an Otology, Head and Neck Surgery, Paediatric Otolaryngology, Maxillofacial or even a General Paediatric and General Surgery practice. There is a need to highlight the clinical features which can aid in accurate diagnosis.
  A case of an adult with Work Type 2 first branchial cleft duplication anomaly presenting as a collaural fistula is described. It first presented as a recurrent upper neck abscess in childhood. The diagnosis had previously been missed although the patient was able to clearly establish a correlation between digging of the ipsilateral ear and precipitation of the abscess. Instead of an epidermal web, a myringeal lesion in the form of a fibrous band-like was present. The lesion was completely excised with no further recurrence.
  
  
  CONCLUSIONS
  This case highlights useful diagnostic features both from the history and physical examination. The specialist/subspecialist must be aware of this condition and be mindful of its possible cross specialty/subspecialty symptoms and signs. Together with a good understanding of the regional embryology and anatomy, the lesion can be diagnosed early at initial presentation with the potential for best treatment outcomes.
authors.affiliation: Department of Otolaryngology, Singapore General Hospital.
authors.forename: Y S
authors.initials: YS
authors.lastname: Tham
authors.forename: W K
authors.initials: WK
authors.lastname: Low
mesh_terms: D001934:Branchial Region / Q000002:abnormalities* / Q000601:surgery; D017577:Cutaneous Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D004424:Ear Canal / Q000196:embryology; D006801:Humans; D008297:Male; D008875:Middle Aged