Cysts and fistulas arising from the first branchial cleft are an uncommon condition of the neck. Although the general subject of the branchial cleft organ has been adequately covered in the otolaryngology literature, case reports of the first branchial cleft anomaly appear to be scarce. In American medical literature,1-5 17 fistulas and 14 cysts have been reported under the diagnosis of the first branchial cleft anomaly. Only 1 fistula was reported in the Japanese literature. The purpose of this paper is to report a case of the first branchial cleft fistula with a short review of facts concerning this Topography of the first branchial cleft anomaly was first described by Frazer9 in 1923 based on embryological anatomy. He predicted its position would be below the eustachian tube, behind the tensor palati, and in front of the carotid artery and stylopharyngeus muscle. The site of cutaneous opening of the