Abstract
First Branchial Cleft Anomaly (FBCA) is an uncommon congenital anomaly that may mimic other periauricular lesions. A two-yearold male child presented with a right infra-auricular pit present at birth and eight months of intermittent painful swelling with foulsmelling whitish discharge following spontaneous rupture. An examination showed a sinus tract scar. Computed Tomography (CT) sinogram demonstrated a tract extending toward the floor of the External Auditory Canal (EAC), consistent with a Type II first branchial cleft sinus. After the infection resolved, the cyst was completely resected while preserving the facial nerve. Histopathology revealed a cyst with a keratinising stratified squamous lining, lamellated keratin, and no adnexal or mesodermal structures, confirming an Epidermoid Inclusion Cyst (EIC).