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Summary Congenital parotid salivary fistulas are unusual entities that can arise from accessory parotid glands or, even more infrequently, from normal parotid glands via an aberrant Stensen's duct. A unique case of a congenital parotid salivary fistula presented in a four-week-old infant as polycystic swelling of the buccal region, with cyst contents draining to a cutaneous pit near the oral commissure. This patient offered an initial diagnostic challenge until it became evident that the drainage represented a salivary fistula. The case is used here to highlight the overlapping clinical and pathologic features shared between type I branchial cleft anomalies and congenital salivary cysts. This case is the second report of buccal salivary cysts in structural association with a congenital parotid salivary fistula and the first such case in which a normal Stensen's duct orifice has been preserved.