Anomalies of the first branchial cleft are rare congenital malformations of the head and neck, making up 8% of all branchial cleft anomalies. Presented here is a case of a 41-year-old female patient with a 30-year history of mild swelling inferior to the left lobulus auriculae, who complained of discharge from the left ear which responded to external otitis media treatment. She presented with discharge from a fistula opening on the posteroinferior aspect of the left mandibular angle of one-year duration. Following extensive workup and surgical exploration, it was discovered that the fistula tract traversed across the midline of the neck, deep to the main trunk of the facial nerve with an opening at a point anteroinferior to the left external acoustic meatus. The main trunk of the facial nerve and it branches were first isolated, followed by complete excision of the fistula tract along with surrounding skin and cartilage which formed part of the external acoustic meatus. The patient did not show any signs of postoperative facial weakness. In spite of their rarity and the difficulties associated with making a correct diagnosis, anomalies of the first branchial cleft should always be considered in the differential diagnosis, particularly in patients with ear discharge resistant to treatment despite the presence of an intact ear drum.