First branchial cleft cyst: A rare presentation with mesotympanic extension

A 2-year-old girl presented with a left middle ear cholesteatoma. A CT scan showed a mass in the left middle ear starting from the mesotympanum extending through a bony canal defect into the parapharyngeal space, deep to the facial nerve and ending in the submandibular region. The patient underwent surgical excision of the first branchial cleft cyst by superficial parotidectomy with facial nerve dissection and mastoidectomy with middle ear exploration. This case illustrates a rare presentation of a first branchial cleft cyst with histologic and anatomical features of both types of Work's classification of brachial cleft anomalies. (C) 2008 Elsevier Ireland Ltd. All rights reserved.