First branchial arch abnormalities are rare. Surgical excision is the mainstay of treatment and described in the literature. Excision can be associated with significant complications. We describe factors influencing operative and non-operative management of patients.

Case review was conducted between January 2012 and September 2022 of patients with first branchial arch abnormalities at Alder Hey Children’s Hospital, UK. Analysis of electronic patient records, operation notes and extraction of clinical outcomes were obtained.

Four patients were identified with an average age of 2 years and 4 months. Three were female. Three underwent operative intervention, one of which had a recurrence post-operatively and was manged conservatively. The non-operatively managed patient remains conservatively managed with no complications.

First branchial arch abnormalities can be managed operatively and non-operatively, depending on patient factors. Steps to improve surgical planning such as constructive interference in steady state magnetic resonance imaging may help decision making and risk stratification of operative management.