It is the wish of all parents to have a healthy baby. But often God is not fair and allows newborn babies to come into the world with congenital diseases. While lamenting, it is important to find good treatment for the sick baby and give the baby a happy and healthy future. Let the shadow of the congenital disease disappear from the child’s memory as soon as possible. Here I would like to explain in detail the symptoms and treatment of first gill fistula. First gill fistula is the result of abnormal development of the first gill fissure, which is closely related to the external auditory canal and is also called congenital external auditory fistula. In the fourth week of embryonic life, the first gill slit sulcus gradually sinks deeper and deeper, and its dorsal surface becomes the original external auditory canal, the middle part forms the earnail cavity, and the ventral end disappears. If the ventral aspect of the first gill sulcus disappears incompletely during the second to fourth month of embryonic life, the ectodermal tissue that is closely related to the external auditory canal can be formed. The different variants of gestational age that appear as developmental disorders may manifest in various forms such as cysts, fistulas or sinus tracts, which may be present alone or accompanied by malformations of the auricle and external auditory canal, with the same pathological features as congenital auricular fistulas. The condition is fetal in origin and is closely related to the external auditory canal, a common feature of the first gill fistula. The cystic type manifests as a progressively enlarging cystic mass below the earlobe, without adhesion to the surface skin, often on the deep side of the superficial lobe of the parotid gland, partially enclosed in the parotid gland, adjacent to the extratemporal trunk segment of the facial nerve. When inflammation is present, the mass can be significantly enlarged and painful, and after the inflammation subsides, the mass can be reduced in size but does not disappear. If the inflammation worsens, an abscess is formed and the skin in the subauricular region ulcerates and drains pus to form a long-lasting postauricular fistula. This disease should be differentiated from parotid cyst or subauricular lymphadenitis, or tuberculosis of the ear. The sinus tract type presents as a mass behind the ear or under the earlobe and is the same as the cyst type. The difference is that there is a sinus tract connected to the external auditory canal, and there is a fistula remaining between the cartilaginous and bony segments of the external auditory canal, forming a sinus tract extending from the isthmus of the external auditory canal to the posterior or inferior part of the auricle. Due to the narrow sinus canal, the ectodermal tissue discharge accumulates in the distal end and becomes a sac, which can become a fistula if the infection drains pus and ulcerates behind the ear or in the subauricular area. 3. Fistula type This malformation has two openings, internal and external. The external opening is below the earlobe or in a part of the line between the front of the sternocleidomastoid muscle and the posterior angle of the mandible, and the internal opening can be different depending on the gestational age of the developmental disorder. (1) Simple fistula: formed by abnormal development of the first gill slit, the internal opening is at the isthmus of the external auditory canal (junction of bone and cartilage). (2) Complex fistula: the developmental disorder appears before the formation of the atresia and the communication between the first pharyngeal bursa and the first gill fissure; in this type, the internal opening of the fistula composed of the ectoderm can be traced to the tympanic cavity or the eustachian tube, which develops from the pharyngeal bursa. The nature of the cystic mass and the location of the fistula are the basis for clinical diagnosis and differentiation. The presence of a fistula can be examined by staining and injection of X-ray contrast to understand its location, course, and the presence of an internal orifice. It should be distinguished from parotid cysts, auricular lymph node enlargement, and ear tuberculosis. If there is an infection, anti-infective treatment is needed first. If an abscess is formed, it should be first incised and drained, and then excision should be performed after the acute inflammation has subsided through local drug changes. 1.Anesthesia is performed under local anesthesia, and general anesthesia can be used for those who cannot cooperate individually. 2.The incision is made in a line from the lower part of the postauricular groove to the upper part of the mandibular angle, which is determined according to the size of the cyst and the location of the fistula. The procedure can be performed under the direction of the injected dye or under the guidance of a probe. This fistula or cyst can be around the facial nerve and often has adhesions if there is a history of recurrent infection. When performing dissection of the subauricular region, care must be taken to protect the trunk segment of the facial nerve and its branches. During surgery, all epithelial tissue should be removed, the incision can be closed in one stage, and in those with infection it is advisable to put drainage and remove it after 24h. Without treatment, repeated infections are inevitable, and in severe cases, the facial nerve can be damaged and peripheral facial palsy can occur. Incisions that do not heal or recur after surgery are due to residual epithelial tissue in the capsule wall or canal wall. Postoperative facial palsy can be caused by intraoperative anesthesia or surgical traction and is temporary. If the facial nerve trunk or its branches (most commonly the mandibular rim branch) are accidentally damaged, permanent paralysis may occur and should be promptly explored and repaired.