An Effective Surgical Approach for the Management of Recurrent First Branchial Cleft Fistula with Cysts: A Case Report.

The goal of this case report is to describe an unusual case of recurrent first branchial cleft fistula with cysts and the effective surgical approach of complete removal with preservation of the facial nerve. A 27-year-old woman presented to our clinic after unsuccessful removal twice during the last 20 years. We have achieved satisfactory outcomes by using an approach to identify the facial nerve at the stylomastoid foramen with canal wall up mastoidectomy under a microscope. No sign of facial palsy, hearing loss, or recurrence were noted in postoperative follow-up. This approach might facilitate the complete dissection of scar and lesions of recurrent first branchial cleft anomalies around the main trunk of the facial nerve in the parotid gland.