First Branchial Cleft Cyst

• SSx: usually presents as a preauricular cyst (may also be infra- or postauricular), opening within external auditory canal

1. Type I: ectodermal elements only; duplicated external auditory canal; typically begin periauricularly, pass lateral (superior) to facial nerve, parallel the external auditory canal, and end as a blind sac near the mesotympanum

2. Type 2: more common; ectodermal and mesodermal elements; duplicated membranous external auditory canal and pinna; presents near the angle of the mandible, passes lateral or medial to facial nerve, may end near or into the external auditory canal

• Rx: fUll excision after resolution of infection (risk of facial nerve injury), may need superficial parotidectomy, avoid incision and drainage

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