Clinical Photo of The Week: Vol1No5

This case was presented in the otolaryngology news (Vol1No5):
An 11-year old male presented with persistent discharge of clear fluid from the point arrowed in this picture during eating. The only significant history was that of I&D of a 'boil' on the cheek by a GP at age of 6 years. Examination showed an oblique puckered scar above the angle of right mandible (displayed on this picture). Radiological contrast injected through the discharging focus ended blindly in a pouch. Right parotid sialogram was abandoned because of difficulty in visualizing right Stenson's duct
Diagnosis: Sialo-cutaneous Fistula, resulting from iatrogenic I&D. The initial 'boil' might have been parotid sialoadenitis. If this patient had no history of trauma, then first branchial cleft might be the likely diagnosis