Bilateral, non-syndromic second branchial cleft fistula in an 8-year-old child: a case report

BACKGROUND: Second branchial cleft anomalies are the most common congenital cervical malformations, accounting for approximately 90% of branchial cleft lesions. They usually present unilaterally, while bilateral involvement is exceedingly rare and most often associated with genetic syndromes such as branchio-oto-renal (BOR) syndrome. CASE PRESENTATION: We report the case of an 8-year-old Moroccan boy with no relevant past medical history who presented with bilateral, low-lying paramedian cervical fistulas that had been recurrently infected since early childhood. Clinical examination revealed two small external openings with intermittent mucopurulent discharge. Audiological evaluation was normal, and renal ultrasonography excluded any associated anomalies. The patient underwent complete surgical excision of both tracts in a single-stage procedure. The postoperative course was uneventful, and no recurrence was observed during follow-up. CONCLUSION: This case highlights the exceptional occurrence of bilateral second branchial cleft fistulas in the absence of syndromic features. A systematic preoperative evaluation, including auditory and renal assessment, is essential. Complete surgical excision remains the gold standard to prevent recurrence and recurrent infections.