Three years ago, Little Feather was born. The baby’s arrival made the family busy and happy. When the baby was half a year old, her mother overheard a “small hole” as big as a pinhole on the skin of her right jaw angle, but didn’t pay much attention to it. A few months later, the skin on the right side of the baby’s jaw was as red and swollen as a dragon’s eye, so she went to the local hospital and was diagnosed with a congenital first gill fistula combined with infection. The parents were reluctant to operate on their child because of the fear of facial paralysis after surgery. After anti-infection and incision and drainage treatment, the inflammation was temporarily relieved. In the year that followed, the fistula became infected four more times and often required incision and drainage. The parents finally brought their child to the Guangdong Provincial People’s Hospital, and through a thorough examination and preoperative preparation, after the local inflammation subsided, Xiao Yu underwent a delicate surgical procedure. After the surgery, Xiao Yu’s bright smile made his parents, who had been worried about his facial paralysis, breathe a sigh of relief. According to Chen Liangzi, deputy director of the Department of Otolaryngology, Head and Neck Surgery at Guangdong Provincial People’s Hospital, congenital first gill fissure is a relatively unknown gill-derived disease of the neck, including three types of fistulas, sinus tracts and cysts, the first two types are common and often develop in preschool children. The sinus tract type has only an internal or peri-auricular fistula opening, with the internal fistula opening mostly in the external auditory canal, which is difficult to detect. External fistulae are present at birth as pinpoint-sized skin depressions that are located near the underside of the earlobe and are not easily detected. In cases of combined infection, there is localized redness, swelling, heat, pain, or ulceration of pus, and recurring attacks may result in granulation or scar tissue. The cystic type often presents as a cystic mass in the parotid area in front of the ear. A clear diagnosis can be made based on history, typical symptoms and imaging studies (e.g. MRI). Once diagnosed, congenital first gill fissure malformation should be operated after the inflammation has subsided in order to cure it. Since the first gill fissure malformation is closely related to the facial nerve, surgery should be performed with complete removal of the fistula, sinus tract or cyst, while protecting the facial nerve. It is important to emphasize that age is not a contraindication to surgery. Intermittent anti-infective treatment is only a reprieve, and frequent incisions to drain the pus not only traumatize the child and affect the aesthetics of the face and neck, but also increase the difficulty of subsequent surgery and the risk of facial nerve injury.