|Year : 2019 | Volume
| Issue : 1 | Page : 31-33
Surgical excision of preauricular sinus
Ashok Sharma, Vivek Taneja, Meenakshi Mehra, Pulkit Khandelwal, Madhurima Banerjee
Department of ENT, Sanjay Gandhi Memorial Hospital, New Delhi, India
|Date of Web Publication||19-Jun-2019|
Dr. Vivek Taneja
Department of ENT, Sanjay Gandhi Memorial Hospital, Mangolpuri, New Delhi
Source of Support: None, Conflict of Interest: None
Background: Preauricular sinus is a congenital anomaly affecting both sexes. The sinus can be located near the tragus. The main difficulty arising in the treatment is the recurrence. Methods: A simple sinectomy technique along with dye infiltration and guidewire probing was used. Result: None intra-operative, post operative or complication related to local anaesthesia were seen, The surgical site healed well in all except for two patients who had wound infections which were managed by antibiotic therapy. Conclusion: A recurrence-free success rate could be achieved with the combination of dye infiltration, guidewire probing, and en bloc excision of the sinus tract and its branches.
Keywords: Congenital anomaly, preauricular abscess, preauricular sinus, sinectomy surgical excision
|How to cite this article:|
Sharma A, Taneja V, Mehra M, Khandelwal P, Banerjee M. Surgical excision of preauricular sinus. Indian J Otol 2019;25:31-3
| Introduction|| |
As first described in 1865 by Van Heusinger, preauricular sinus is a congenital anomaly arising due to the malfusion of the six hillocks, three arising from the first arch and the other three arising from the second branchial arch as suggested by His in 1885. It is variably also termed as preauricular pit, preauricular fistula, preauricular tract, and preauricular cyst. Commonly it is unilateral [Figure 1], but bilateral occurrences have also been noted and cited. A few syndromes have also been reported in the association of the preauricular sinus such as the branchio-oto-renal syndrome, Beckwith–Wiedemann syndrome, Treacher–Collins syndrome, and hemicranial microsomia syndrome.
In 2006, Kim et al. stated that majority of the cases remain asymptomatic for which there is no necessity to provide any kind of treatment, while some may present with facial cellulitis, recurrent pre auricular abscess which would require antibiotic therapy against the causative organism and at times incision and drainage. Surgical excision is advised during the quiescent phase of the recurrent inflammatory cycle. Sometimes the disease is mis-diagnosed as a sebaceous cyst or a furunculus.
The incidence of preauricular sinus ranges from 0.1% to 0.9% in the Caucasian population, and higher incidences have been reported in the African and East Asian populations (4% and 10%, respectively). More specifically, they are found with an estimated incidence of 0.1%–0.9% in the United States and Europe, 2.5% in Taiwan, 4%–10% in some African countries, and 2.53% in Korea.
| Methods|| |
The present study was performed during May 2018 and September 2018, on all the patients undergoing surgical treatment for preauricular sinus at the Department of ENT, Sanjay Gandhi Memorial Hospital, Mangolpuri, New Delhi. A total number of 23 patients were included in the study [Table 1]. The indications for the surgery [Table 2] were odor and discharge, recurrent infections, and patients requiring surgery for cosmetic reasons.
The patients with active infection were first treated with antibiotic therapy and incision and drainage followed by antibiotic therapy and then taken up for the surgery.
On the day of the surgery, the sinus was first infiltrated with methylene blue dye followed by administration of local anesthesia. Then, a guidewire probe was gently introduced till the resistance was felt. An elliptical incision was used around the sinus opening, and blunt dissection was done to identify the complete sinus tract and the various branches traced and excised in total. The wound was closed in layers.
| Results|| |
Out of all the patients taken up for surgery, none of them had any intraoperative complications or postoperative complications. None of them had any complications related to local anesthesia. The surgical site healed well without any wound dehiscence and surgical site infection in all except for two patients who had wound infections which were managed by antibiotic therapy.
Postoperatively, none of the patients reported with any abscess formation or recurrence.
| Discussion|| |
The embryological formation of the pinna occurs from the first and second brachial arch through six hillocks, and the improper fusion of these six hillocks results in the formation of the preauricular sinus; the location of the preauricular sinus is closely related to the tragus and the anterior part of the helix. Ideally, the patients of preauricular sinus should also be scanned for other congenital anomalies and renal infection; out of all the patients taken up for surgery, none of them had any congenital anomaly but they were not scanned for any renal infection as the aim of the study was to note postoperative complications and recurrence.
In the present study done at Sanjay Gandhi Memorial Hospital, preauricular sinuses were noted in both the sexes male as well as female, on comparison, more in males which is in variation from other studies stating a predominant occurrence in females. About 20 of the cases were unilateral and only three patients were with bilateral sinus.
For the present study the technique of simple sinectomy involving methylene blue dye infiltration and guide wire probing was used. All the cases were followed up till date. Initially the patients were instructed to visit the OPD on weekly basis for first two weeks, after that to visit twice on an interval of 15 days and finally were told to report immediately if any complication or infection occured. Within the follow up period Out of all the patients taken up for surgery none of them had any intra-operative complications or post-operative complications. None of them had any complications related to local anaesthesia. The surgical site healed well without any wound dehiscence and surgical site infection in all except for two patients who had wound infections which were managed by antibiotic therapy [Table 3].
Postoperatively, none of the patients reported any abscess formation or recurrence.
| Conclusion|| |
In the present study done at Sanjay Gandhi Memorial Hospital, pre auricular sinuses were noted in both the sexes males as well as females, on comparison more in males which is in variation from other studies stating a predominant occurrence in females. 20 of the cases were unilateral and only three patients with Bilateral sinus. A recurrence free success rate could be achieved with the combination of dye infiltration, guide wire probing and en block excision of the sinus tract and its branches. Out of the total number of patients taken up for surgery only two patients had wound infections which were managed by antibiotic therapy.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Baarsma EA. Surgical treatment of the infected preauricular sinus. Arch Otorhinolaryngol 1979;222:97-102.
Gupta R, Agrawal A, Poorey VK. Preauricular sinus: A clinicopathological study. Int J Res Med Sci 2015;3:3274-7.
Yeo SW, Jun BC, Park SN, Lee JH, Song CE, Chang KH, et al.
The preauricular sinus: Factors contributing to recurrence after surgery. Am J Otolaryngol 2006;27:396-400.
Kim JR, Kim DH, Kong SK, Gu PM, Hong TU, Kim BJ, et al.
Congenital periauricular fistulas: Possible variants of the preauricular sinus. Int J Pediatr Otorhinolaryngol 2014;78:1843-8.
Baatenburg de Jong RJ. A new surgical technique for treatment of preauricular sinus. Surgery 2005;137:567-70.
[Table 1], [Table 2], [Table 3]