First branchial cleft anomalies, first described by Sir. James Paget(1878), are rare clinical condition represent about 1% of all branchial cleft anomalies. Since the initial description, first branchial cleft anomalies have been reported only sporadically. It is a persistent branchial remmant and may present as a cyst or a sinus. First branchial cleft anomalies are often misdiagnosed because of its rarity, and incomplete excision leads to recurrence. Recently, we have experienced 5 cases of first branchial cleft anomalies, which were treated with surgical excision without any complication and recurrence.