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Objective: To investigate the embryologic origin and diagnosis and management of cutaneous cartilage remains of gill origin in the neck. Methods: A total of 15 patients with cervical chondrocutaneous branchial remnants treated in Guangdong Provincial People's Hospital from January 2005 to December 2021 were retrospectively analyzed. They had a common feature showing a tumor in the lower third of the front of sternocleidomastoid muscle. The tumor looked like accessory auricle, never appeared pain or other symptoms of infection, and had no skin orifice. All patients underwent ultrasound examination, which showed an anechoic area under subcutaneous tissue of the neck or face. MRI examination in 6 cases showed subcutaneous irregular nodules the location of the lesion. Surgical resection of cervical chondrocutaneous branchial remnants was performed in all cases. Results: Postoperative pathological examination showed elastic cartilage. No complications were noticed. Recurrence was not observed in the cases by following-up of 8 months to 52 months（median: 41 months）. Conclusion: Cervical chondrocutaneous branchial remnants are relatively rare, which may originate from the second branchial arch and may be associated with other congenital malformations. The curative treatment is a complete excision preschool., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To discuss the clinical application and significance of the modified piriform fossa fistulectomy based on segmental anatomy of fistula. Methods: The clinical data of 84 patients with CPSF treated by modified pyriform sinus fistulectomy were analyzed retrospectively. The modified piriform fossa fistula resection adopts the fistula anterograde anatomy method to fine dissect the fistula. The operation procedure can be summarized into four parts: retrograde anatomy of recurrent laryngeal nerve, anatomy of external branch of superior laryngeal nerve, anterograde anatomy of fistula and partial thyroidectomy. Results: All 84 patients successfully completed the operation and discharged from the hospital. The operation time was（64.6±20.0） min, the intraoperative bleeding was（19.6±13.0） mL, and the average hospital stay was（6.8±1.1） d. Postoperative infection occurred in 1 case（1.19%）, temporary vocal cord paralysis in 1 case（1.19%）, no bleeding, pharyngeal fistula, dysphagia, permanent vocal cord paralysis and choking cough. The incidence of complications was 2.3%（2/84）. No complications such as permanent vocal cord paralysis and hypothyroidism occurred. Follow up for 57-106（Median 74） months showed no recurrence. Conclusion: A modified procedure based on segmental dissection of the fistula not only simplifies the traditional procedure, but also procedures the specific steps to provide a targeted and precise resection, which provides a proven surgical solution for complete eradication of the lesion and significantly reduces complications and recurrence., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

A 6 year-old boy, who complained right neck abscesses and X-ray showed left pyriform fistula, was diagnosed as bilateral pyriform sinus fistulas. For bilateral pyriform sinus fistulas, endoscopic CO2laser cauterization should be the first treatment choice., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

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., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)