Type II first branchial cyst and sinus excision with preservation of facial nerve and parotid gland

We describe a rare case of type II first branchial cleft sinus and cyst, which was misdiagnosed and mismanaged for many years before being correctly diagnosed and managed. A 3-year-old girl had been seen 16 times over a 3-year period for a recurrent discharging sinus before a correct diagnosis of a first branchial cleft cyst and sinus was made. The patient had an uneventful recovery following total excision of the sinus and cyst with preservation of the facial nerve and parotid gland. We report a novel technique of anatomical and electrophysiological identification of facial nerve and preservation of the facial nerve and parotid gland in type 2 first branchial sinus and cyst deep to the facial nerve trunk involving superficial and deep lobes of the left parotid gland.