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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 24  |  Issue : 2  |  Page : 91-94

Clinical features of preauricular sinus and recurrence rate of supra-auricular approach


Department of Otolaryngology-Head and Neck Surgery, Pyongyang Medical College Hospital, Kim Il Sung University, Pyongyang, Democratic People's Republic of Korea

Date of Web Publication4-Sep-2018

Correspondence Address:
Mr. Jin-Ho Kim
Department of Otolaryngology-Head and Neck Surgery, Pyongyang Medical College Hospital, Kim Il Sung University, Ryonhwa-Dong, Central District, Pyongyang
Democratic People's Republic of Korea
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/indianjotol.INDIANJOTOL_149_17

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  Abstract 


Objective: The objective of this study was to analyze the clinical features of preauricular sinus and the recurrence rate of supra-auricular approach. Materials and Methods: A total of 87 patients (96 ears) treated for preauricular sinus at the Department of Otolaryngology-Head and Neck Surgery, Pyongyang Medical College Hospital, Kim Il Sung University, between January 2007 and December 2016 were enrolled in this study. Results: The prevalence of preauricular sinus was more common in teenage group (55.2%). Preauricular sinus occurred more frequently in male (1.4 times). The most common type of preauricular sinus was marginal helicine type with 86.5%. The recurrence rate with supra-auricular approach was found to be 3.3% whereas simple sinusectomy was 17.1%. Conclusion: The most common type in the preauricular sinus was marginal helicine type and supra-auricular approach was a reliable technique which had significantly less recurrence rate.

Keywords: Congenital malformation, preauricular fistula, preauricular sinus, simple sinusectomy, supra-auricular approach


How to cite this article:
Song-Hwan O, So IK, Kim JH. Clinical features of preauricular sinus and recurrence rate of supra-auricular approach. Indian J Otol 2018;24:91-4

How to cite this URL:
Song-Hwan O, So IK, Kim JH. Clinical features of preauricular sinus and recurrence rate of supra-auricular approach. Indian J Otol [serial online] 2018 [cited 2018 Dec 13];24:91-4. Available from: http://www.indianjotol.org/text.asp?2018/24/2/91/240568




  Introduction Top


Preauricular sinus, first described by Heusinger in 1864, is a benign, congenital malformation of the preauricular soft tissue and located at the anterior margin of the ascending limb of the helix.[1]

The incidence varies globally and is estimated to be 0.1%–0.9% in the United States, 0.9% in England, and 4%–10% in some areas of Asia and Africa.[2],[3]

Preauricular sinus is more often unilateral and sporadic. Bilateral cases are more likely to be inherited. When inherited, the pattern is of incomplete autosomal dominance with reduced (around 85%) penetrance.

Research in China has mapped a possible locus for congenital preauricular fistula to chromosome 8q11.1-q13.3.[4]

The formation of preauricular sinus is closely associated with the development of auricle.

The auricle develops from six mesenchymal proliferations of first and second branchial arches during the 6th week of gestation.

The first and second branchial arches give rise to three hillocks separately.

Three hillocks from the first branchial arch will form the tragus, helical crus, and helix.

Further, three hillocks from the second branchial arch will form antihelix, scapha, and lobule.

These hillocks fuse to form the definitive auricle between 7th and 8th week of gestation. Incomplete fusion of these hillocks will lead to preauricular sinus, malformation of the external ear.[5]

Congdon et al. suggested clinical classification according to the sites of orifice of preauricular sinus by incomplete fusion theory.[6]

The majority of patients with preauricular sinus are asymptomatic and it requires no treatment.[7]

Once infected, it occurs more often acute exacerbation.

Recurrent or persistent infection of the preauricular sinus should be excised during a period of quiescence.

The standard technique for excision of the preauricular sinus is to excise an ellipse of skin around the orifice and to dissect out the individual tract, the simple sinusectomy.

Most postoperative recurrences result from incomplete removal of the epithelial lining.

The recurrence rates of simple sinusectomy have been reported between 9% and 42%.[8]

The more radical technique supra-auricular approach was made by Prasad et al. in 1990.[9]

Supra-auricular approach was based on the theory that a fistula is almost always included in subcutaneous tissues between temporalis fascia and perichondrium of the helix cartilage. Therefore, all the tissue superficial to the temporalis fascia is removed together with preauricular sinus. A portion of the cartilage along the base of the preauricular sinus should also be excised.[10]

Supra-auricular approach reported low recurrence rate of 5%.[9]

The main goals of this study are to (1) summarize the clinical features of preauricular sinus and (2) evaluate the recurrence rate of supra-auricular approach.


  Materials and Methods Top


Between January 2007 and December 2016, 87 patients (96 ears) with symptomatic preauricular sinuses underwent surgical excision at the Otolaryngology-Head and Neck Surgery Department, Pyongyang Medical College Hospital, Kim Il Sung University.

Thirty-five out of 96 ears received simple sinusectomy and the rest (61 ears) underwent supra-auricular approach.

All infections were treated with appropriate antibiotics until the acute inflammation subsided.

We analyzed the ratio of male to female, age group of the highest prevalence, the most common type of preauricular sinus according to Congdon's classification, clinical presentation, and recurrence rate.

All the patients were followed up for at least 3 months after operations.


  Results Top


The prevalence of preauricular sinus was analyzed according to age groups.

Especially, patients of teenage group constituted the largest proportions accounting for 55.2%.

Preauricular sinus occurred more frequently in male with 1.4 times than female [Table 1].
Table 1: Age and sex distribution

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Preauricular sinus was mostly unilateral; left side was more common, present in 54.0% followed by the right side in 35.6%.

Bilateral cases were presented in 10.4% [Table 2].
Table 2: Laterality of preauricular sinus

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The prevalence according to the sites of orifices of preauricular sinus is shown in [Table 3].
Table 3: Prevalence according to Congdon's classification

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The most common type of preauricular sinus was marginal helicine type with 86.5%.

Common presenting complaints were 81.5% ear pain, 75.3% preauricular swelling, and 69.4% ear charge. The other symptoms are given in [Table 4].
Table 4: Clinical presentations of preauricular sinus

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The recurrence rates of preauricular sinus according to operative methods were followed. The recurrence rate with supra-auricular approach was found to be 3.3% whereas simple sinusectomy was 17.1%.

The significant difference was observed in the recurrence rate between supra-auricular approach and simple sinusectomy (P < 0.05) [Table 5].
Table 5: Recurrence rate

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  Discussion Top


The incidence of preauricular sinus varies globally.

The incidence in Asia and Africa has been reported 4%–10% higher than in Europe and the United States.[2],[3]

Jimoh et al.[3] have studied about the prevalence of preauricular sinus among Nigerians and reported that the prevalence was higher in 1–18 years old.

Gupta et al.[11] have reported 42.3% in teenage group.

In this study, the prevalence of preauricular sinus was highest in teenage group than other one.

Most investigation showed that sex ratio varies, and in our study, preauricular sinus occurred more frequently in male (1.4 times).

Preauricular sinuses are often unilateral; both right and left ears are affected, with a slight predominance for the right ear.[3]

In our study, preauricular sinus was 1.5 times in left side more than right one.

Preauricular sinus occurs frequently at the anterior margin of the ascending limb of the helix.

However, they have also been reported to occur along lateral or posterior margin of the helix, the tragus, or the lobule.[12],[13]

Congdon et al. suggested clinical classification of preauricular sinus based on the embryology of auricle [Figure 1].[6]
Figure 1: Congdon classified as preauricular type (A), marginal helicine type (B), crural type (C), posterior helicine type (D), postauricular type (E), helico-lobular type (F), central lobular type (G)

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Ohashi had studied the Congdon's classification and reported that margin helicine type accounted for 80%–90% and crural type was about 10%.

In our study, marginal helicine type was 86.5% and crural type was 12.5%.

Once infected, it can occur pain, swelling, and abscess of preauricular area.

In the acute phase of infection, treatment comprises administration of appropriate antibiotics and incision and drainage of an abscess if present.

If recurrent or persistent infection present, preauricular sinus should be excised.

The aim of operation is to excise the epithelial lining completely, but incomplete removal of sinus tract can cause the recurrence.

In 1990, Prasad et al. described a new surgical technique that named supra-auricular approach.[9]

There are many reports that supra-auricular approach statistically has lower recurrence rate than simple sinusectomy.[14],[15]

In our study, supra-auricular approach had significantly less recurrence rate with 3.3% than simple sinusectomy.


  Conclusion Top


Preauricular sinus occurred more frequently in male with 1.4 times, and its prevalence was higher in teenage group than other one.

The significant difference was observed in the recurrence rate between supra-auricular approach and simple sinusectomy (P < 0.05).

Supra-auricular approach is an adequate surgical technique for the excision of preauricular sinus.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Heusinger HK. Hals-Kiemen finstein von noch nicht beobacheter form. Virchows Archiv 1864;29:358-80. doi10.1007/BF01937182.  Back to cited text no. 1
    
2.
Ewing MR. Congenital sinuses of the external ear. J Laryngol Otol 1946;61:18-23.  Back to cited text no. 2
    
3.
Jimoh OR, BS Alabi, SS Adebayo. Prevalence of preauricular sinus among Nigerians. Surg J 2008;3:61-3.  Back to cited text no. 3
    
4.
Zou F, Peng Y, Wang X, Sun A, Liu W, Bai S, et al. Alocus for congenital preauricular fistula maps to chromosome 8q11.1-q13.3. J Hum Genet 2003;48:155-8.  Back to cited text no. 4
    
5.
Wilson CP. The etiology of the preauricular sinuses. Acta Otolaryngol 1959;50:225-31.  Back to cited text no. 5
    
6.
Congdon ED. Rowhanavongse S, Vara-Misara P. Human congenital auricular and Juxta-auricular fossae, sinuses and scars (including the so-called aural and auricular fistulae) and the bearing of their anatomy upon the theories of their genesis. Am J Anat 1932;51:439-63.  Back to cited text no. 6
    
7.
Schwartz RH, Badalyan V, Bahadori RS. Neonatal pre-auricular pits/sinuses: Survey of management strategies by pediatric otolaryngologists. Open J Pediatr 2012;2:181-5.  Back to cited text no. 7
    
8.
Currie AR, King WW, Vlantis AC, Li AK. Pitfalls in the management of preauricular sinuses. Br J Surg 1996;83:1722-4.  Back to cited text no. 8
    
9.
Prasad S, Grundfast K, Milmoe G. Management of congenital preauricular pit and sinus tract in children. Laryngoscope 1990;100:320-1.  Back to cited text no. 9
    
10.
R. K. Mundra, Richi Sinha, Richa Agrawal. Supra-auricular approach: A simple Recurrence Free-Technique for Pre-auricular sinus. EJNSO 2014;1:11-5.  Back to cited text no. 10
    
11.
Gupta R, Agrawal A, Poorey VK. Preauricular sinus: A clinicopathological study. Int J Res Med Sci 2015;3:3274-7.  Back to cited text no. 11
    
12.
Chami RG, Apesos J. Treatment of asymptomatic preauricular sinuses: Challenging conventional wisdom. Ann Plast Surg 1989;23:406-11.  Back to cited text no. 12
    
13.
Chang PH, Wu CM. An insidious preauricular sinus presenting as an infected postauricular cyst. Int J Clin Pract 2005;59:370-2.  Back to cited text no. 13
    
14.
Saeed Gohar M, Khan MF, Khan S. Pre-auricular sinus and its management by supra-auricular approach. Pak J Med Health Sci 2009;3:208-10.  Back to cited text no. 14
    
15.
El-Anwar MW, ElAassar AS. Supra-auricular versus sinusectomy approaches for preauricular sinuses. Int Arch Otorhinolaryngol 2016;20:390-3.  Back to cited text no. 15
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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Abstract
Introduction
Materials and Me...
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