First branchial cleft anomalies are extremely rare and account for less than 8% of all branchial anomalies. They are generally found in infancy although they arise during the embryonal period because of an incomplete closure of the first branchial cleft. In 1972 Work classified first branchial cleft anomalies into two types: Type I, ectodermal cysts, is a duplication of the external auditory duct; Type II, originate in both ectodermal and endodermal components and contain cartilage. The present case report describes a Type II branchial malformation. G.M., a 2-year-old male, presented painful tumefaction in the left parotid area with cutaneous fistulization between the sternocleidomastoid muscle and the mandibular angle. Cranial CT permitted diagnosis and made it possible to stage surgery. The difficulties encountered in recognizing and diagnosing first branchial cleft anomalies are often responsible for application of the wrong surgical approach and the resulting frequency in recurrences.