Buccal salivary cysts in association with a congenital parotid salivary fistula

Congenital parotid salivary fistulas are unusual entities that can arise from accessory parotid glands or, even more infrequently, from normal parotid glands via an aberrant Stensen's duct. A unique case of a congenital parotid salivary fistula presented in a four-week-old infant as polycystic swelling of the buccal region, with cyst contents draining to a cutaneous pit near the oral commissure. This patient offered an initial diagnostic challenge until it became evident that the drainage represented a salivary fistula. The case is used here to highlight the overlapping clinical and pathologic features shared between type I branchial cleft anomalies and congenital salivary cysts. This case is the second report of buccal salivary cysts in structural association with a congenital parotid salivary fistula and the first such case in which a normal Stensen's duct orifice has been preserved.