First branchial cleft anomaly.

A first branchial cleft anomaly is an unusual clinical condition and the clinical picture is similar to that seen in other much more common diseases. This combination may result in a diagnostic delay and insufficient and dangerous primary surgery, resulting in facial nerve damage. This paper reviews the embryological background of first branchial cleft anomalies, the varying clinical presentation and the surgical treatment, illustrated by three case histories. A revision of the most common classification system is proposed.