Surgical Approaches to First Branchial Cleft Anomaly Excision: A Case Series

Figure 5

Case  5. (a)(1-2) CT scan with contrast, axial cuts demonstrating a left rim-enhancing postauricular abscess (arrow) adjacent to the conchal bowl (where puncta were identified at time of surgery), causing EAC stenosis (arrowhead). (b) Modified Blair incision incorporating postauricular granulation tissue (site of prior I&D). The limb of the marked incision extending down along a neck crease was marked as a possibility but not incised during the surgery, since it was unnecessary for visualization of the digastric and SCM muscles. (c) After identifying the facial nerve, an elliptical incision was carried out around the antitragal pit and dissected down. (d) Both the gentian violet within the tract and the lacrimal probe were used throughout the case to identify the tract. After initial dissection, the ellipsed skin around the pit and the contiguous tract was passed deep to the auricle and brought out through the postauricular incision keeping the entire tract intact.

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