Duplication of the external auditory canal: a report of three cases

Objective: Malformations of the first branchial cleft are uncommon and only sporadically reported in the literature. They may present as inflammatory openings on the neck, bland cysts or fistula associated with the external a uditory canal. In this retrospective study, clinical features and anatomica l relationships are described in three pediatric cases. Therapeutical guide lines for surgical management of first branchial cleft anomalies are discus sed. Patients: Between 1997 and 1999 three patients aged 9 months, 2 and 7 years with first branchial cleft anomalies were included in this study. All pati ents were treated surgically, wide exposure and superficial parotidectomy w as necessary for complete removal in two of three cases. Results: Exploring patients histories revealed previous infections with rep eated incision and drainage procedures as well as inadequate operative rese ctions. Clinically, purulent drainage From the ear, swelling in the parotid area and abscess formation with persistent drainage after incision in the neck or parotid area were noted. Conclusions: From our case series two of three patients underwent inadequat e incision and drainage procedures to combat infection followed by scar tis sue formation. Because of the variable relation to the facial nerve this le d to difficulties in identifying and protecting the nerve during definite s urgery. Management of first branchial cleft anomalies must include the faci lities to achieve ear surgery and superficial parotidectomy including facia l nerve exposure. (C) 2001 Elsevier Science Ireland Ltd. All rights reserve d.