First branchial cleft anomalies are rare congenital malformation of the head and neck. They occur above the level of the hyoid bone and have a close anatomic relationship to the facial nerve due to their embryologic origin. In this article, we will review the development and derivatives of the first branchial apparatus followed by the epidemiology and classification of these lesions. The treatment of choice for first branchial anomalies is surgical resection, which will be the focus of this article.
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