Reconstruction Of External Auditory Canal Research Articles

External auditory canal reconstruction using a novel mastoidoplasty technique during canal wall down mastoidectomy: how I do it.

While mastoid obliteration techniques have received much attention in decreasing the disadvantages associated with the resultant mastoid cavity from canal wall down procedures, techniques for an anatomically normal looking ear canal reconstruction to increase the feasibility of hearing aid fitting are less commonly discussed as an alternative. Our mastoidoplasty technique basically utilises an inferiorly based periosteal flap with or without temporalis muscles and fascia to obliterate the epitympanum and reconstruct the external auditory canal (EAC). Stay sutures are used to keep them in place. For larger cavities, demineralized bone matrix (DBM) is used to obliterate the mastoid cavity and support the neo-EAC. The concept of our mastoidoplasty potentially provides a very useful alternative in recreating a near normal ear canal anatomy avoiding cavity problems as well as facilitating hearing aid fitting with canal type hearing aids after canal wall down mastoidectomy.

Three cases of uncommon medication‐associated osteonecrosis of temporal bone

AbstractIntroductionMedication‐related osteonecrosis of the temporal bone is rare and has been reported to be associated with the use of anti‐resorptive and biologic agents. Here, we present the first case of tyrosine‐kinase inhibitor‐related external auditory canal (EAC) osteonecrosis as well as two cases related to anti‐resorptive therapies.MethodsA retrospective case series.ResultsCase one: an 84‐year‐old female presented with chronic otitis externa and osteonecrosis of EACs bilaterally. She had a history of osteoporosis treated with denosumab and risedronic acid. She successfully underwent left EAC reconstruction using an inferiorly‐based pedicle periosteal flap while the right ear canal was managed conservatively. Case two: a 69‐year‐old male presented with osteonecrosis of the right EAC. He had a history of osteoporosis treated with alendronic acid and zoledronic acid. His osteonecrosis is conservatively managed with local debridement and antibiotic application. Case three: a 60‐year‐old male presented with osteonecrosis of the right inferior EAC. He had a history of chronic myelogenous leukemia treated with a tyrosine‐kinase inhibitor, imatinib. After failing conservative therapy, he underwent right ear canal reconstruction using a periosteal vascular pedicle flap without complication and experienced complete resolution to his symptoms.ConclusionAnti‐resorptive agents and/or tyrosine kinase inhibitors may lead to dysregulation of bone remodeling and result in rare cases of temporal bone osteonecrosis. When a local debridement and antibiotic therapy fail, definitive surgical excision of necrotic bone with subsequent reconstruction of the EAC may offer patients a possible resolution in symptoms.

The cover of an ear thermometer probe as a split-thickness skin graft mold in external auditory canal reconstruction.

Maintaining the patency of the external auditory canal (EAC) during reconstruction is important because of its physiological role in hearing and immunological protective functions. The curved shape of the EAC presents a challenge when performing a skin graft. One of the key points for a successful skin graft is to ensure compression on the wound bed, and many novel methods, including prefabricated ear molds, have been reported for this purpose. In this study, we present a case of a skin graft performed to reconstruct a skin defect following excision of actinic keratosis in the EAC, using the cover of an ear thermometer probe as a mold for the graft to match the curvature of the EAC. This is an economical and practical method for secure compression dressing of a skin graft in the EAC.

Comparative study of pre- and postauricular flaps for external auditory canal defect reconstruction

BackgroundMalignancies involving the external auditory canal deserve critical evaluation due to this area's aesthetic and functional importance. Flaps can be very useful for the restoration of the external auditory canal. A variety of flaps available for the surgical treatment of external acoustic meatus defects exist, depending on the precise location and size. ObjectivesOur study aimed to compare aesthetic and functional results in the postoncological reconstruction of external auditory canal defects using a preauricular flap and postauricular revolving door flap. MethodsSixteen patients treated at our plastic surgery unit for defects involving the external auditory canal between January 2014 and December 2020 were included in the study. All defects were the result of a primary or secondary skin cancer excision. Patients were divided into two groups, one receiving the preauricular flap technique and the other the postauricular revolving door flap technique. ResultsThree separate visual analog scales reported excellent scores for the two procedures, though the postauricular revolving door flap had slightly better results. Both preauricular flap and postauricular revolving door flap reconstructive techniques showed good options for external auditory canal reconstruction in postexcision skin cancer patients. From an aesthetic point of view, the revolving door flap appeared to be a more elegant surgical approach in this type of reconstruction because the scar was hidden in the postauricular sulcus. ConclusionsReconstruction with a postauricular revolving door flap allowed for a more natural movement with no external pedicle. Evidence-Based Medicine (EBM) LevelIV

Modified—modified radical mastoidectomy

PurposeIt is unusual to have communication from the external auditory canal (EAC) directly to the mastoid, totally sparing the tympanum. These patients need a different surgical approach, a modified canal wall-down procedure, to completely clear the disease but fully preserve the tympanum. We present one such exceptional case.Case presentationA 28-year-old lady presented with ear discharge for 1 year. Imaging confirmed the canal-mastoid fistula, but the entire tympanum was normal. We performed a modified-modified radical mastoidectomy.ConclusionsCanal-mastoid fistula is an infrequent entity and may be idiopathic. Despite being evident on clinical examination, imaging aids in assessing size and location of the defect. Although EAC reconstruction may be attempted, the majority require a canal wall-down procedure.

A Case of Reconstruction of Large Defect in Posterior Wall of Bony External Auditory Canal Using Cavum Conchal Cartilage

External auditory canal (EAC) wall defect may occur due to cholesteatoma, and surgeries for chronic ear diseases, trauma, neoplasm or idiopathic. Conservative treatment is available if the severity of the symptom is mild or asymptomatic. However, these defects require repairment not only to attain relief from intermittent otologic symptoms but also to prevent retraction pockets and sequential cholesteatoma. There have been no reported cases of reconstruction of EAC wall defect by cartilage with perichondrium and groove of wall defect by drilling. We manipulated the conchal cartilage so that it could effectively provide robust reconstruction of the canal wall defect. Herein we report a case of EAC reconstruction with mastoidectomy with no further complications.

Mastoid obliteration and canal wall reconstruction with posterior auricular artery (PAA) fascia-periosteum flap

ObjectiveUnstable cavities are defined as cavities with cerumen accumulation that need frequent cavity cleaning in the out-patient clinic, cavities that are intolerant to water due to risk of infection or that are subject to frequent infection and otorrhoea. The objective of this study is to address the problem of troublesome mastoid cavities, with the performance of secondary mastoid obliteration and canal wall reconstruction, using a novel posterior auricular artery (PAA) fascia-periosteum flap. Materials and methodsA prospective study was designed, only secondary obliterations were included. Unstable mastoid cavities were defined as Merchant grade 2 or 3 and were included for surgery. ResultsAt 12 months of follow up, a complete external auditory canal (EAC) and a self-cleaning ear were achieved in all 23 patients. Completely dry ears were achieved in 21 patients (91.3%). An air-bone gap improvement of 5dB was achieved. ConclusionMastoid obliteration and EAC reconstruction are effective procedures to treat troublesome post canal wall down mastoid cavities. They improve quality of life and enable patients to overcome ear discharge. A standard EAC size enables the utilization of conventional hearing aids, it also reduces the need for constant mastoid cleaning and decreases healthcare expenses. The PAA flap seems to be an effective procedure to achieve all these features, as it is used to obliterate the mastoid and becomes a structural component of the neo-EAC.

Mastoid obliteration and external auditory canal reconstruction using 3D printed bioactive glass S53P4 /polycaprolactone scaffold loaded with bone morphogenetic protein-2: A simulation clinical study in rabbits.

IntroductionThe lack of good prosthetic materials and objective standards has limited the promotion of mastoid obliteration and external auditory canal reconstruction, and the quality of the surgery varies. In this study, bioactive glass S53P4 (S53P4), the most popular artificial prosthetic material, was modified and combined with polycaprolactone (PCL) and bone morphogenetic protein-2 (BMP-2) to produce an individualized biological scaffold using 3D printing technology to explore a better material and method for mastoid obliteration and external auditory canal reconstruction.Methods3D-printed S53P4/PCL scaffolds were fabricated from 3D reconstruction data of bone defect areas in New Zealand rabbits simulating “Canal Wall Down Mastoidectomy”. The water absorption, swelling rate, porosity, and Young's modulus of the scaffold were measured, and the morphology and pore size of the scaffold were observed using scanning electron microscopy. The cytotoxicity of the S53P4/PCL scaffolds was detected using the CCK8 assay, and the in vitro antibacterial activity of the S53P4/PCL scaffolds was detected using the inhibition circle method. The BMP-2-loaded S53P4/PCL scaffolds were prepared using the drop-in lyophilization method and implanted into animal models. The biocompatibility, osteogenic activity, and external auditory canal repair of the scaffolds were observed using endoscopy, micro-CT, and histological examination.ResultsThe S53P4/PCL scaffold was highly compatible with the defective area of the animal model, and its physicochemical properties met the requirements of bone tissue engineering. In vitro experiments showed that the S53P4/PCL scaffold was non-cytotoxic and exhibited better antibacterial activity than the same volume of the S53P4 powder. In vivo experiments showed that the S53P4/PCL scaffold had good biocompatibility and osteogenic activity, and could effectively repair bone defects and reconstruct the normal morphology of the external auditory canal in animal models. Furthermore, its osteogenic activity and repair ability were significantly improved after loading with BMP-2.ConclusionsThe 3D printed S53P4/PCL scaffold has great potential for clinical mastoid obliteration and external auditory canal reconstruction.

[Using the external auditory canal skin graft of the healthy side to treat unilateral congenital aural atresia: preliminary results of clinical research].

Objective: To investigate whether the contralateral normal external auditory canal (EAC) skin graft can maintain the ear canal health after EAC reconstruction in unilateral congenital aural atresia (CAA) cases. Methods: A Zelen design randomized controlled study was used to collect unilateral CAA patients for EAC reconstruction prospectively (clinical trial registration number: ChiCTR2000032103). The patients were randomly divided into the control group and the trial group. The trial group used the contralateral normal EAC skin graft group (transplant part of the contralateral normal EAC skin to repair the atresia side for unilateral CAA patients), the control group all used scalp blade thick skin. We observed the EAC health and hearing results of the two groups after EAC reconstruction. Results: A total of 13 cases were enrolled from July 2020 to August 2021. There were eight patients in the trial group, including six males and two females, with an average age of 22.3 years (14-36 years). There were two patients with CAA on the left and six patients on the right. The average follow-up time was 8.8 months (4-14 months). There were five patients in the control group, all cases were male with an average age of 16.2 years (12-20 years). There were four patients with CAA on the left and one patient on the right. The average follow-up time was 7.0 months (2-14 months). In the trial group, eight cases of reconstructed EAC epithelium were healthy, one patient had cicatricial stenosis of EAC opening and lateralization of the tympanic membrane. The other patient had cicatricial stenosis of reconstructed EAC, this case also had scar hyperplasia of the contralateral EAC opening but recovered after soft packing and triamcinolone acetonide injection treatment. The healthy side EAC of the rest trial group had no scarring stenosis or local bone hyperplasia during long-term follow-up. In the control group, one patient was lost to follow-up and the other four patients had dry ears of reconstructed EAC, but easily to form crusts and needed to be cleaned repeatedly, one patient had lateralization of the tympanic membrane, the EAC epithelium was not healthy for long-term follow-up. The incidence of complications related to EAC reconstruction was lower than previous studies (χ²=5.55, P=0.018), and the average postoperative Air-Bone Gap increased (18.8±10.0)dB. Conclusion: By optimizing the EAC reconstruction technology, the health of the reconstructed EAC is improved compared with the previous study. After active intervention and treatment, there should be no scarring stenosis or local bone hyperplasia on the contralateral side EAC.

Superficial temporal artery capillary perforator-based island flap for conchal bowl and external auditory canal reconstruction

Reconstruction of the auricle is challenging to surgeons as a result of its complex anatomy. Defects including the conchal bowl and the external auditory canal (EAC) do not accept imperfection as functional consequences may add to aesthetic ones. Local flaps that are relying mainly on posteriorly based auricle flaps do not represent ideal solutions. This study aims to report the perforator modification of an anteriorly based pre-auricular flap that matches all requires goals of reconstruction. From 2015 to 2019, three capillary perforator-based island flaps (c-PBIF), with the Superficial Temporal Artery (STA) as source pedicle, were performed to reconstruct a combined Conchal Bowl-External Auditory Canal (CB-EAC) defect, secondary to basal cell carcinoma resection. Free margins were obtained via the Tubigen micrographic approach. All three flaps were raised on the perforator originating from the superficial temporal pedicle. In 2 of the cases, the perforator was found at the level of the tragus while in the last case, it was found 1cm more distal. Capillary perforators were isolated and dissected down to their origin from the STA thereby increasing their arc of rotation and pliability. The median follow-up time was 4 years. All flaps survived. Aesthetic results were excellent leaving no distortion of the external ear and the hollow aspect of the conchal was well supported. The tragus mount was preserved, EAC lining was secured, and good audition was restored with no bulging of the flap into the canal in all the cases. Harvesting pre-auricular flaps as c-PBIFs are safe and acts as an excellent solution for the reconstruction of the challenging combined CB-EAC defect. It allows a one-stage reconstruction that does not need a secondary revision, it also gives excellent correction and functional results. We would recommend it as a useful option for the reconstruction of the conchal-EAC defects.

Recessive Dystrophic Epidermolysis Bullosa: Rare Bilateral External Auditory Canal Stenosis and Surgical Treatment

Epidermolysis bullosa (EB) is a family of rare genetic disorders affecting the skin and mucous membranes, causing blisters and lesions. Its treatment is based on the prevention of traumatic events that could favor the onset of blisters as well as careful wound care. New therapies, including gene therapy, are under investigation. In the case described here, a rare localization of EB at the level of the ear canal is described. To our knowledge, no surgical option for treatment has previously been described in the literature. The clinical features observed and the therapeutic modalities adopted are presented and discussed. A 56-year-old female patient came to our attention for bilateral progressive hearing loss. The patient was suffering from Dystrophic EB. Surgical correction of the stenosis through a retroauricular approach was planned, with the simultaneous reconstruction of the right external auditory canal using the canaloplasty technique combined with Thiersch skin grafting. The case we report here is, to our knowledge, the second describing the surgical treatment of ear canal stenosis secondary to EB. As a result of surgical correction of the stenosis, the ear regained its physiological function and there was an improvement in hearing. In the subsequent post-operative controls, there was no recurrence of the disease, from which the patient is still free 36 months after surgery. Although conservative treatment is a solid choice, our experience seems to indicate that the surgical option allows better management of the Dystrophic EB in the external auditory canal.

Mastoid obliteration and external auditory canal reconstruction with silicone block in canal wall down mastoidectomy.

ObjectiveTo prevent cavity problems in canal wall down mastoidectomy, silicone block for mastoid obliteration was used.MethodsIn this retrospective cohort study, 39 patients (21 males and 18 females) underwent canal wall down mastoidectomy and mastoid obliteration using silicone block. We evaluated the postoperative outcome, the time until epithelialization of the cavity, graft success rate, and the hearing outcome.ResultsThe time until complete epithelialization of the mastoid cavity was 35.5 ± 5.4 days. We had a graft success rate of 100% during the follow‐ups. The postoperative evaluation revealed 36 dry ears (92.3%) patients without any cavity problems. However, one ear developed granulation tissue, and two ears had partially exposed silicone block, which required revision mastoidectomy. Regarding hearing outcomes, a complication such as deaf ear was not reported.ConclusionSilicone block is safe and suitable for mastoid obliteration and external auditory canal reconstruction in canal wall down mastoidectomy.Level of Evidence4.

Reconstruction of the Anterior External Auditory Canal With Mastoid Cortex Autologous Bone Graft.

To describe the surgical management of temporomandibular joint (TMJ) herniation with external auditory canal (EAC) reconstruction using autologous bone grafting from the mastoid cortex. Retrospective case series. A tertiary university medical center. Three patients who presented to our Otolaryngology clinic with evidence of TMJ herniation through an anterior EAC defect, both on otoscopy and computed tomography (CT) imaging. Reconstruction of the anterior EAC with mastoid cortex bone grafting using an endaural approach. Successful reconstruction of anterior EAC bony defect without recurrence of herniation. All three patients presented with otalgia, hearing loss, and either tinnitus or a clicking sensation with jaw movement. Etiologies for TMJ herniation included osteoradionecrosis following external beam radiation therapy for head and neck carcinoma and iatrogenic injury following multiple tympanoplasties and canalplasties. A mastoid cortex bone graft was placed and secured anterior to the bony EAC defect through an endaural approach. Two patients wore a dental retainer postoperatively to keep the condyle in an open position. After reconstruction, patients reported an improvement in their presenting symptoms. There was no recurrence of TMJ herniation in all cases after 1, 4, and 9 years. Anterior EAC reconstruction with autologous bone grafting can be an effective definitive treatment in TMJ herniation. To our knowledge, this is the first report of the use of bone grafting to reconstruct the canal defect in TMJ herniation.Level of Evidence: V.

Comparative study of the external auditory canal in humans and large mammals.

Given the limited source of human external auditory canal (EAC) skin, animal experiments remain an important approach for studying functional EAC reconstruction. However, differences between humans and animals in terms of the general EAC structure, histological characteristics of EAC skin, and cell markers of its specific glands in cartilaginous EAC skin remain unknown. We compared the characteristics of the EAC between humans and large animals, as a basis for appropriate animal model selection. Temporal bone computed tomography was used to compare the EACs of humans, goats, pigs, and dogs. EAC skin samples were harvested and their histological characteristics evaluated. The skin's ultrastructure and the histological structure of specific glands and cell markers related to cell phenotype and function were further identified. The EAC structure in goats was similar to that in humans in terms of diameter, length, and cartilaginous segment ratio of the EAC, while that of pigs and dogs differed markedly. Furthermore, histological evaluation showed that there were abundant ceruminous and sebaceous glands in the goat's cartilaginous skin, while dogs and pigs showed notably fewer of these glands in cartilaginous skin than humans. Nevertheless, ceruminous glands in all species studied showed similar expression of cell biomarkers and secretion function. Goats might have advantages in terms of surgery and reconstruction of the functional EAC skin compared to dogs and pigs and can be a useful candidate for ceruminous gland cell sources.

A one-stage method for external auditory canal reconstruction; the Wessex pre-auricular flap

This technique has been developed with the aim of expanding the well documented pre-auricular flap to help reconstruct pinna lesions that extend into the external auditory canal. This area can be a challenge to reconstruct effectively to minimise morbidity and there are limited published techniques. This flap is a reproducible, one-stage technique that is readily available to most ENT surgeons, avoiding stenosis and allowing for adequate reconstruction of the external auditory canal.

Four layers reconstruction of the posterior ear canal wall in one stage surgery

<p class="abstract"><strong>Background:</strong> Canal wall down mastoidectomy are still practiced in cases of chronic suppurative otitis media with cholesteatoma to ensure complete disease removal. The resulting cavity is prone to recurrent infection, chronic discharge and frequent care. Reconstruction of the posterior canal wall should be planned by the surgeon. Various techniques for external auditory canal (EAC) reconstruction have been recommended to eliminate open cavity problems. The surgeon should choose the type of grafts either autologous, homografts or synthetic materials. Furthermore, the surgeon should decide whether to do the reconstruction either immediate in the first stage of surgery or delayed as a second stage.</p><p class="abstract"><strong>Methods:</strong> In this study, the ridge was reconstructed at the same time of mastoidectomy by autologous tissues. The presenting study reconstructed the posterior canal wall in four layers; skin, perichondrial flap, cartilage and periosteal flap in that order from the meatal side to the mastoid side. The presenting study included 48 patients (32 males and 16 females) with age ranged from 18-55 and 20-50 years. All included patients were presented at the outpatient clinic with unilateral chronic suppurative otitis media with persistent discharge. They had been operated at our tertiary hospital between January. 2012 to March 2014.</p><p class="abstract"><strong>Results:</strong> Successful reconstruction was obtained in all cases, with no dehiscence or necrosis.</p><p class="abstract"><strong>Conclusions:</strong> The reconstruction of the posterior wall by the four layers technique was successful and efficient. It is recommended to do this repair concomitantly with canal wall down mastoidectomy as one stage surgery.</p>

Reconstruction of the external auditory canal using full-thickness rolled-up skin graft after lateral temporal bone resection for T1 and T2 external auditory canal cancer

ObjectiveTo present our results of the external auditory canal (EAC) reconstruction procedure using rolled-up full-thickness skin graft with tympanoplasty after lateral temporal bone resection (LTBR) for early-stage EAC carcinoma. Patients and MethodsA retrospective review of 15 patients who had undergone LTBR with reconstruction of the EAC for T1 and T2 EAC cancer between 2016 and 2020. ResultsPostoperative mean air-bone gap was 30.7 decibel hearing level. Although a few patients experienced chronic granulation, persistent otorrhea, and/or laterization of the tympanic membrane, most patients showed no serious complications related to the EAC reconstruction. ConclusionEAC reconstruction using a full-thickness skin graft in combination with tympanoplasty is useful for minimizing the hearing loss, maintaining the cosmetic appearance, and facilitating the observation into the ear cavity.

Mastoid cavity obliteration in treatment of middle ear cholesteatoma

Objective: The primary goal in the surgical management of chronic otitis media with cholesteatoma is the creation of a dry and safe ear. The method of choice for management of cholesteatoma is the inside out or reverse mastoidectomy. If external auditory canal reconstruction after complete cholesteatoma removal is not possible, mastoid cavity obliteration techniques are recommended to reduce the size of the open mastoid cavity. The goal of our study is to evaluate the frequency of postoperative ear secretion and hearing situation in patients with mastoid cavity obliteration in treatment of middle ear cholesteatoma. Methods: Retrospective study of 155 patients with middle ear cholesteatoma were surgically treatment during 52 months from 01.06.2014 to 30.09.2018 in Hospital Trakia Park, Stara Zagora (Bulgaria) with canal wall reconstruction or mastoid cavity obliteration with cartilage, bone pate or bone replacement alloplastic materials. Results: After complete cholesteatoma removal we perform ear canal reconstruction in 51.61% of cases (80; n=155), and in others 41.94% of cases (65; n=155) we perform mastoid cavity obliteration. In our patient group we perform type I tympanoplasty in 36.77% (57; n=155), type III tympanoplasty in 46.45% (72; n=155), Secondlook operations in 14% (21, n = 155) and only in 5 cases we left the operating cavity open (3.23%; n=155). After mean follow-up period from 11.34 months (1÷48 months; SD 13.10 months) our frequency of postoperative ear secretion is 6.45% (10; n=155) and our cholesteatoma residual rate is 9.03% (14; n=155). Conclusion: Mastoid cavity obliteration procedures can prevent the development of postoperative retraction pockets by isolation the tympanic cavity from the attic and mastoid. This is a safe and effective technique for rehabilitation of mastoid cavities. Hearing results of this technique is variable according to the involvement of the middle ear ossicles, but with the possibility of fitting a hearing aids or middle ear implants.

External auditory canal reconstruction with inferior pedicled square screw flap from the preauricular area after resection of external auditory canal cancer.

BackgroundThe postoperative reconstruction of ear canal cancer with a local flap such as the snail flap technique has been reported for cases with few tissue defects. The snail flap technique requires a large skin incision and is at risk of facial neuropathy. We have devised a new flap that addresses these problems.MethodsAn 80‐year‐old woman underwent total right ear canal resection for cancer of the right ear canal, and the defect of the ear canal was reconstructed using a local flap. The local flap was used by making a rectangular incision in front of the auricle and rolling it into a cylindrical shape. We named this flap a square screw flap.ResultsThe patient was discharged 1 week after surgery without complications.ConclusionsThis method is considered to be useful for reconstruction of the ear canal with a small defect.

[Classification and surgical strategy of Work Ⅰ congenital first branchial cleft anomaly based on adjacent anatomy].

Objective:To explore the adjacent anatomic relationship and classification of Work Ⅰ congenital first branchial cleft anomaly（CFBCA） in order to guide clinical practice. Method:The data of 48 cases of Work Ⅰ CFBCA with complete data were analyzed retrospectively. Result:All 48 lesions were completely resected. 48 sides（100.0%） were anatomically preserved facial nerve, partial parotidectomy was performed on 33 sides（68.8%）, superficial lobe+deep lobe partial parotidectomy was performed on 9 sides（18.8%）, and 6 sides（12.5%） was not performed parotidectomy. External auditory canal reconstruction was performed on 32 sides（66.7%）; 43 sides（89.6%） underwent the anatomical preservation of the auricular lobe branch of the great auricular nerve; 9 sides（18.8%） was performed selective cervical lymphadenectomy at the same time. 45 sides of Work Ⅰ CFBCA presented irregular cystic or lobulated structure, the lesion was located below and behind the junction of the external auditory meatus bone and cartilage and distributed along the longitudinal axis of the external auditory canal; 3 sides were isolated in superficial lobe parenchyma of parotid gland. All lesions were located on the superficial surface of the main trunk and branches of the facial nerve. The average value of the shortest vertical distance between the lower edge of the lesion and the outlet of the main trunk of the facial nerve at the stylomastoid foramen was 7.2 （0-13.4 ）mm. Based on preoperative images and intraoperative findings, according to the adjacent relation with external auditory meatus , parotid gland and facial nerve, the classification of Work Ⅰ congenital first branchial cleft anomaly is proposed, which is specifically divided into 4 types: C1（posterior wall of the external auditory meatus） 17 cases（35.4%）, C2（inferior wall of the external auditory meatus） 13 cases（27.1%）, C3 （multi wall of the external auditory meatus） 15 cases（31.3%）, C4（isolated from parotid gland parenchyma） 3 cases（6.3%）. Conclusion:Work Ⅰ CFBCA has a close relationship with the adjacent anatomy of the region, and familiar with the classification of Work Ⅰ congenital first branchial cleft anomaly is helpful for the treatment of type and accurate resection.