Preservation of facial nerve in surgery of first branchial cleft anomaly: five cases of duplicated external ear canal

ABSTRACT

We report five cases of duplicated external ear canal with especial attention to its histology and surgical care of facial nerve for their complete resection. These five patients were selected from 50 cases of first bronchial cleft anomalies including atretic external ear canals, preauricular fistula, cyst and sinuses. The characteristic histopathology and clinical features such as external opening around the auricle and upper neck above the level of the hyoid bone were not observed in other patients. There were no other abnormalities in the real external ear canal [EEC] and auricle. Three of them were connected to the natural EEC with an opening, hence producing ear discharges. Histologic appearances of well formed canal included a circumferential epithelial lined up and canal consisting of stratified squamous epithelium with skin adnexes. A remarkable cartilaginous skeleton [type 2 of first branchial cleft anomaly according to Work's classifications] was also observed. All of them were treated surgically, with preservation of the facial nerve and excising the superficial parotid gland along with the ductal opening and the tract