First Branchial Cleft Sinus

Khalid Al Aboud, MD, Khalid Al Hawsawi, MD, V. Ramesh, MD, Daifullah Al Aboud, MD, Ahmed Al Githami, MD


Skinmed. 2003;2(1) 

In This Article


The crusted lesion was located in the lower right retroauricular area opposite the ear lobule. Removal of the crust revealed a circular 1.5-cm diameter eroded red plaque surrounded by an erythematous halo (Figure 1). On gentle compression, scanty discharge was seen coming out of a small opening nearly in the center of the plaque. The adjoining structures, including the external ear, appeared normal. There was no regional lymphadenitis. The oral cavity appeared normal.

An erythematous plaque behind the left ear.

Routine blood investigations and an x-ray of the chest were within normal limits. The Mantoux test done by intradermal injection of 0.1 mL of purified tuberculin on the flexor surface of the forearm read negative after 48 hours. Streptococcus pyogenes was cultured from the discharge and it was sensitive to penicillin, cephalosporin, and erythromycin, and resistant to cotrimoxazole. On review, the previous histopathology showed the presence of an inflamed sinus lined partly by granulation tissue and partly by keratinizing stratified squamous epithelium (Figure 2). In the granulation tissue there was a heavy infiltrate with signs of acute and chronic inflammation. The inflammatory cells comprised mainly neutrophils, lymphocytes and plasma cells (Figure 2). No atypical cells were seen in the section. The acinar pattern of salivary gland tissue and scattered lymphoid aggregates were also visualized in the section. Based on these clinical features, the child was diagnosed to have first branchial cleft sinus.

A sinus tract lined by stratified squamous epithelium. Chronic inflammatory infiltrates are also seen. (Hematoxylin-eosin stain; original magnification x 40).

The child was given a course of antibiotics for the infection to clear. Two weeks later he was given a date for excision by the pediatric surgeon. The patient never turned up for operation or follow-up.