PURPOSE: Congenital lesions account for more than half of the excised cervical masses in children, and 20% of these cervical masses are caused by branchial anomalies (BA). BA can present as a cyst, sinus, fistula or skin tag and they are the result of maldevelopment of the branchial apparatus during the embryonic period. In this study we sought to review the presentation, work-up, treatment and outcome of BAs in a pediatric population. METHODS: Forty-two pediatric patients who were treated for BA over an 11-year period starting from June 1997 at Keimyung University Dongsan Medical Center were investigated to assess the relative frequency of the type of BA, the preoperative manifestations, the preoperative diagnostic modalities and the surgical complications. RESULTS: There were 21 (50%) branchial sinuses, 12 (29%) branchial cysts, 6 (14%) branchial fistulas and 3 (7%) skin tags with a cartilaginous remnant. Among the 42 BAs, 13 (31%) were previously infected. Based on embryological classifications, there were 32 (76%) second BAs, 5 (12%) 3rd and 4th BAs, 1 (2%) 1st BA, and 4 (10%) unclassified BAs. We experienced 1 postoperative recurrence and 1 temporary facial nerve palsy that developed during excision of a 1st branchial cyst. Histopathological study of the lining epithelium demonstrated squamous epithelium in 19 BAs (45%), respiratory epithelium in 8 BAs (19%), squamous and respiratory epithelium in 4 Bas (10%), no epithelium with fibrosis in 8 BAs (19%), and others in 3 BAs (7%). CONCLUSION: Branchial sinuses are most common by morphology and 2nd branchial anomalies by embryology. The preoperative infection rate was 31%. The every effort to find out the exact anatomical location of the lesions is necessary to minimize postoperative recurrence by complete excision.