First branchial cleft anomalies are uncommon but may occur anywhere from the external auditory canal to the angle of the mandible, including the parotid gland. Although several attempts have been made to classify first branchial cleft anomalies by location and histology, they are currently considered a spectrum of malformations. They arise from incomplete closure of the ectodermal portion of the first branchial cleft. The defect may be a fistula, a sinus, or a cyst. Depending on the extent of the fusion anomaly, the lesion may involve the external auditory canal, mandibular, and hyoid region, and it may end in submandibular region. Cysts associated with the external auditory canal usually present with aural fistulas, auricular swelling, otitis, and otorrhea and may be related to the parotid gland, which is found lying either within deep or superficial to it. Diagnosis of such embryonic malformations superficial to the parotid can be difficult without surgical exploration.