A Surgical Technique for Congenital Preauricular Sinus

Management of the infected preauricular sinus

INTRODUCTION

The preauricular sinus is a common finding in children and may often be complicated by infection. Complete excision of the sinus is the only definitive cure. Failure to recognise the presence of a sinus, particularly when infection erupts away from the sinus, may lead to inadequate management and unnecessary surgery.

AIM

We report our experience in managing infected preauricular sinuses and highlight important points in our surgical technique.

METHODS

A retrospective review was performed of our electronic patient database for all paediatric patients who underwent surgical excision of preauricular sinuses by the senior author at Great Ormond Street Hospital for Children between January 2013 and October 2022.

RESULTS

A total of 10 patients underwent surgical management of 11 preauricular sinuses with a median follow-up time of 40 months (range 1-136). Eight patients underwent excision of the preauricular sinus due to infection. All infected cases affected the preauricular cheek skin and had previously undergone at least one unsuccessful surgical drainage prior to a referral to our unit. All cases were successfully operated on at our unit with no reported complications or recurrence.

CONCLUSION

A lack of awareness of the presence of a sinus and identification of a preauricular pit by the inexperienced clinician will result in inadequate treatment of this condition and potentially unnecessary surgical procedures. Our paper highlights the importance of correctly identifying the extent of the sinus and describes a safe and reliable technique to ensure complete removal of the preauricular sinus with satisfactorily low recurrence rates.

Ectopic Unilateral Ear Pit in an Otherwise Well-Appearing Child: A Case Report and Literature Review

Ear pits are a common congenital abnormality that is incidentally found on routine examinations. However, it is not well documented how many are found outside of their classical location or if these ectopic locations put patients at increased risk of having a hearing impairment, renal anomalies, genetic syndromes, or infection. Clinicians should be aware of the current guidelines for recognizing, screening, and evaluating for these risks in patients with ear pits, regardless of location.

Concealed incision for resection of classical preauricular fistula

OBJECTIVE

To introduce a new method of preauricular fistula resection and discuss its clinical efficacy.

METHODS

Clinical data of 40 patients with 40 classical preauricular fistulas in our hospital were collected. The patients comprised of 19 male and 21 female patients aged 3-60 years. The fistula and part of the related cartilage were completely removed by a concealed incision on the inner side of the auricular crus, and the opening of the fistula was retained. The postoperative efficacy was analyzed.

RESULTS

The operation time ranged from 15 to 30 minutes (mean, 25 minutes), and the blood loss ranged from 4 to 8 mL (mean, 5 mL). After complete fistula resection, the wound was closed with interrupted sutures. Dressing changes started 2 days after surgery and performed once a day, and the wound sutures were removed 7 days after surgery. All patients were followed up for 6 to 12 months (mean, 8.7 months) after surgery. Except for one patient with mild wound pain after suture removal, no patients developed infection or recurrence.

CONCLUSION

Use of a concealed surgical incision for treatment of a classical preauricular fistula has good results. There is no obvious scar on the ear after surgery and the procedure does not affect the facial appearance. It not only completely removes the lesion but also meets the patient's esthetic needs.

Summary of the Experience in the Diagnosis and Treatment of Complex Preauricular Fistulas in 78 Children

Objective: This study aimed to investigate the application of mini-incisions in complex preauricular fistula resection in children.

Methods: A total of 78 children who were diagnosed with preauricular fistula infection between January 2017 and December 2019 were included in the study. Their clinical data were analyzed retrospectively, and surgical treatment with mini-incisions based on plastic surgery principles and techniques was provided.

Results: All the patients achieved healing following the first application of the treatment. The patients were followed up for 6–42 months, and no recurrence or local auricular deformation occurred.

Conclusion: The application of mini-incisions and plastic surgery techniques in complex preauricular fistula resection in children can achieve a good effect and improve the satisfaction of the children and their parents.

Minimization of skin incision at preauricular sinusectomy using a trans pit approach

BACKGROUND

We introduced a surgical procedure which includes a simple sinusectomy without opening the sinus whilst attempting to minimize the skin incision.

METHODS

A total of 34 patients with preauricular sinus were treated. In six patients, this technique was performed bilaterally, so a total of 40 ears were enrolled and analyzed for recurrence rate and surgical outcome in retrospective observational study. A database was created which included patient age, the preoperative and postoperative incision size, suture materials used, and complications. Incisional size according to the previous infection condition and incision and drainage (I & D) history were analyzed.

RESULTS

The mean initial skin incision length was 0.75 ± 0.40 cm and mean incision length after skin suture was 0.81 ± 0.42 cm. The young group under 10 years of age had a mean initial skin incision length of 0.56 ± 0.06 cm, and mean incision length after skin suture was 0.58 ± 0.08 cm. Suture materials were Nylon 6-0 for 14 ears, Nylon 7-0 for 20 ears, and Nylon 8-0 for 6 ears. The incidence of minor complications (immediate wound dehiscence, wound opening at a previous I & D region, keloid formation) was 7.5%.

CONCLUSION

Our method overcomes potential problems with esthetics in addition to reducing the recurrence rates of preauricular sinusectomy. With our technique, minimization of skin incision length is possible without the risk of recurrence. The use of fine suture materials and not using drainage avoids additional skin trauma.

Supra-auricular versus Sinusectomy Approaches for Preauricular Sinuses

Introduction Several surgical techniques and modifications have been described to reduce the high recurrence rate after excision of preauricular sinus.

Objectives The aim of this study is to review the literature regarding surgical approaches for preauricular sinus.

Data Synthesis We performed searches in the LILACS, MEDLINE, SciELO, PubMed databases and Cochrane Library in September, 2015, and the key words used in the search were “preauricular sinus,” “sinusectomy,” “supra-auricular approach,” “methylene blue,” and/or “recurrence.” We revised the results of 17 studies, including 1270 preauricular sinuses that were surgically excised by sinusectomy in 937 ears and by supra-auricular approach in 333 ears. Recurrence with supra-auricular was 4 (1.3%) while sinusectomy was 76 (8.1%) with significant difference (p < 0.0001). There were no reported facial nerve paresis or paralysis in any of the approaches. The sinusectomy approach showed significantly more complications (p = 0.0048).

Conclusion Supra-auricular approach had significantly less recurrence rate than tract sinusectomy approaches. Thus, it could be regularly chosen as the standard procedure for preauricular sinus excision. As such, it would be helpful for surgeons to be familiar with this approach.