Goldenhar Syndrome Presenting with Congenital Salivary Fistula from Accessory Parotid Gland: Clinical Management and Psychosocial Implications in a Young Child

Background: Goldenhar syndrome represents a spectrum of congenital anomalies affecting first and second branchial arch derivatives, manifesting with craniofacial, vertebral, cardiac, renal, and neurological abnormalities. The association of congenital salivary fistulas with accessory parotid gland pathology remains exceptionally rare in this syndrome. Objective: To describe an unusual presentation of Goldenhar syndrome with simultaneous occurrence of congenital cheek salivary fistula, accessory parotid gland, parotid agenesis, and preauricular appendages, while emphasizing the psychological impact on the pediatric patient. Case Presentation: A 5-year-old male presented with persistent watery discharge from the right cheek since birth. Clinical examination revealed a single punctum on the cheek, adjacent skin tag, and bilateral preauricular appendages. Imaging with computed tomography fistulography confirmed right accessory parotid gland with patent fistulous tract and ipsilateral parotid agenesis. Renal ultrasonography demonstrated right renal agenesis. Surgical intervention involving accessory parotid gland excision and fistula tract removal was performed successfully under general anesthesia. Histopathological analysis confirmed seromucinous salivary gland parenchyma. Results: Complete symptom resolution was achieved with excellent cosmetic outcomes. The patient demonstrated behavioral improvement and restoration of social confidence at six-month follow-up. Conclusion: While Goldenhar syndrome frequently presents with recognizable craniofacial manifestations, the association with salivary fistulas warrants early identification and intervention to prevent psychological morbidity in affected children. Surgical management requires meticulous dissection due to anatomical distortion and anomalous facial nerve course