This is likely to be a congenital branchial fistula formed as a result of infection in a branchial cyst remnant. Branchial cysts from the first cleft appear at the angle of the mandible whilst those from the second or third pouch are placed anterior to the middle portion of the sternomastoid muscle. Excision is necessary and will require deep dissection for complete removal. Investigation might include a sinogram or possibly MRI scan