To summarise the clinical characteristics and management strategies of congenital auricular malformations with first branchial cleft anomalies (CFBCAs) in children.

A retrospective analysis was conducted on 25 children with complete clinical data who were admitted between January 2020 and January 2025.

All patients presented with unilateral auricular malformations. Five had Grade I microtia, two had Grade II conchal adhesion-type deformity, and 14 had Grade II accessory tragus-type deformity; four had hemifacial microsomia. Nineteen had a history of a preoperative infection. CFBCAs are located near the external auditory canal (EAC) and manifest as sinus tracts, fistulas, or small cutaneous pits on the cheek. Based on anatomical location, CFBCAs were classified as type I (located in the postauricular area with roots attached to the cartilage of the inferior wall, n = 5), type II (located anterior to the tragus with roots attached to the cartilage of the inferior wall, n = 14), and type III (located in the cheek region, which may be accompanied by hemifacial microsomia, with a cartilaginous blind end, n = 6). All the lesions were superficial to the facial nerve. Twenty underwent CFBCA excision combined with auricular deformity reconstruction. During the postoperative follow-up (6 months to 5 years), no facial nerve paralysis, recurrence, or auricular infection occurred; five had mild EAC stenosis.

Paediatric congenital auricular deformities may coexist with first branchial cleft anomalies, Accurate diagnosis and precise classification are essential for lesion identification and complete excision, which improve treatment outcomes.