Excision of the preauricular sinus: a comparison of two surgical techniques

OBJECTIVES: To compare the long-term recurrence rate of the standard technique (simple sinectomy) and the supra-auricular approach (wide local excision) for the surgical management of preauricular sinuses. STUDY DESIGN: Retrospective cohort. METHODS: Fifty-four patients with a preauricular sinus excised between May 1986 and December 1996 were included in this study. All patients were categorized into one of two groups based on the type of surgery performed: the standard technique or the supra-auricular approach. The medical records were then reviewed and the latest information concerning the recurrence of a preauricular sinus were updated by phone interview. The recurrence rate of these two groups was statistically analyzed by the Fisher exact test. RESULTS: Forty-nine of 54 patients were successfully contacted with data updated and analyzed. The 32% recurrence rate of the standard excision (n = 25) was significantly higher than the 3.7% recurrence rate of the supraauricular approach (n = 27; two-tailed test, P = .01). CONCLUSION: The supra-auricular approach for excision of a preauricular sinus has a statistically lower recurrence rate in comparison to the standard technique.     

变异型耳前瘘管的诊治分析

目的探讨变异型耳前瘘管的临床特点及手术技巧。方法收集中山大学附属第一医院2000年1月～2014年5月诊治的320例先天性耳前瘘管患者资料,对其中12例（3.75%）资料完整的符合变异型耳前瘘管的患者进行综合分析,收集其临床症状、既往手术史、家族史、手术方式及复发率等。结果此12例变异型耳前瘘管患者均有过瘘管感染病史。4例开口于耳甲腔或耳甲艇,4耳开口于耳轮脚前及耳后沟,1例开口于耳后沟。2例开口于耳轮脚上及外耳道口边缘。1例开口于外耳道口边缘及耳后沟。术后11例患者伤口Ⅰ期愈合。1例患儿术后5 d出现伤口裂开,耳廓部分软骨外露。经纳米银抗菌凝胶处理伤口1周后,创面二期愈合。随访6个月,未见复发。结论临床上仔细的体格检查将避免变异型耳前瘘管的漏诊。各种手术技巧配合显微镜及新颖的抗菌敷料,是治愈变异型耳前瘘管和减少复发的关键。     

The diagnosis and treatment of a variant type of auricular sinus: postauricular sinus

European Archives of Oto-Rhino-Laryngology - To make otolaryngologists aware of the variant types of auricular sinus, we have performed a systematic review of patient diagnoses and presented our...     

Excision of preauricular sinus with abscess drainage in children

Purpose

To introduce a feasible approach for excising a preauricular sinus with abscess in children.

Isolated preauricular pits and tags: is it necessary to investigate renal abnormalities and hearing impairment?

We investigated the incidence and co-existence of hearing impairment and renal abnormalities in healthy children with preauricular tags and pits. Study population consists of 13,740 primary school children from routine health check. Thirty-five children with preauricular tags and pits were noted. Control group consisted of 91 patients without pits and tags, who underwent renal ultrasound and were scheduled to pediatric outpatient clinic. Urinalysis, renal ultrasound, otoacoustic emission were performed in both the groups. The prevalence of renal abnormality (1/36; 2.7%) and hearing impairment (1/36; 2.7%) in patients with preauricular tags and pits was similar to that of control group (3/91; 3.2% and 4/91; 4.3%) (P = 0.87, P = 0.64, respectively). According to our results, it is not necessary to investigate hearing or urinary abnormality in patients with preauricular tag or pit, unless there is an association of a syndrome or family history of hearing or renal impairment.     

特殊类型先天性耳前瘘管3例

目的提高特殊类型先天性耳前瘘管的诊断与治愈水平。方法对3例特殊耳前瘘管患者的病历资料进行回顾性分析。结果 1例合并先天性颞骨胆脂瘤同期手术;1例瘘管口隐蔽,术中找到瘘管口彻底切除;1例瘘管长,自耳轮脚伸入外耳道深部,后达乳突表面,行双切口彻底切除。结论先天性耳前瘘管伴有听力下降,术前有必要行颞骨CT检查;手术后是否复发取决于瘘管切除是否彻底、被波及的耳郭软骨及感染灶内的肉芽和瘢痕组织。     

Histiocytosis X: otologic presentations

Histiocytosis X is a relatively rare disease presenting as 3 clinical syndromes: eosinophilic granuloma, Hand-Schuller-Christian disease, and Abt-Letterer-Siwe disease. Although the clinical expressions of the disease differ, the underlying histopathology appears to be the same. Since the disease frequently involves and not infrequently presents in the head and neck region, it is particularly relevant to the otolaryngologist. We have recently treated two young children presenting with bilateral otorrhea. Although histiocytosis X was entertained early in the evaluation of these patients, the diagnosis was difficult and prolonged in both cases. One case ultimately required electron microscopic study to confirm the diagnosis. Important aspects of the diagnosis are reviewed. Treatment of histiocytosis X includes surgery, radiation therapy and chemotherapy. These treatment strategies are discussed, with particular emphasis on the management of the ear involvement.     

双梭形切口手术治疗儿童感染期先天性耳前瘘管

目的 探讨双梭形切口手术治疗儿童感染期先天性耳前瘘管的疗效。方法 回顾性分析2017年6月—2019年6月复旦大学附属儿科医院厦门分院收治的85例（85耳）先天性耳前瘘管感染期采用双梭形切口手术治疗患儿的临床资料,观察术后疗效。结果 85例患儿均顺利完成手术,术后7～10 d,83例（83耳）一期愈合,2例二期愈合。所有患儿皮肤表面手术瘢痕均不明显,无耳廓软骨膜炎等并发症,耳廓形态无明显变化,切口愈合达美容缝合效果。术后随访6个月至2年,均无复发,治愈率100%。结论 先天性耳前瘘管感染期行双梭形切口手术治疗,方法简便,兼顾美容效果,创伤小,恢复快,术后效果满意,临床可推广应用。     

The preauricular sinus: factors contributing to recurrence after surgery

PURPOSE: The objective of this study was to summarize clinical presentation, treatment, and recurrence of preauricular sinuses. MATERIALS AND METHODS: This retrospective, institutional review board-approved study reviewed the medical records of patients who underwent preauricular fistulectomy between January 1995 and June 2005 at university-based hospitals in South Korea. Only patients who underwent classic preauricular fistulectomy (not incision and drainage) and could be followed up for at least 3 months were included in the study. RESULTS: A total of 191 patients (206 ears) were enrolled. The right and left ears were involved in 79 and 97 patients, respectively. The most common location of the preauricular pit was the anterior margin of the ascending limb of the helix (93.2%). The most common indication for surgery was the recurrent exacerbation of acute infection (58.3%). The recurrence rate after surgery was 4.9%. Surgery under local anesthesia contributed to recurrence after the procedure (P = .009) and the cases that featured local infiltrative anesthesia had a higher rate of recurrence than the cases that had general anesthesia with an odds ratio of 6.875. CONCLUSIONS: Although this study showed that surgery under local anesthesia contributed to recurrence, it did not mean that it was only the anesthesia technique that influenced the recurrence. Surgeons should bear in mind that complete removal of the epithelial lining provides a lower recurrence rate, especially under local anesthesia. The main limitation of this study was that recurrent cases were too few to allow a statistical analysis.     

耳后注射甲泼尼龙琥珀酸钠联合常规药物治疗重度突发性聋

目的　研究耳后注射甲泼尼龙琥珀酸钠（甲强龙）联合常规药物治疗重度突发性聋的临床效果及副反应,探讨耳后局部给药是否可取代传统全身激素给药方式。方法　选取2014年6月～2015年5月就诊于首都医科大学附属北京安贞医院,符合研究条件的60例（61耳）突发性聋患者,均给予改善微循环及营养神经等常规治疗2周。患者 随机分为两组：对照组（31耳）经静脉给予地塞米松磷酸钠注射液10 mg,每日1次,共5 d;耳后注射组（30耳）耳后注射甲强龙40 mg,每日1次,共5 d。采用SPSS 16.0软件进行统计学分析,比较治疗前后的疗效变化及副反应。结果  给药后两周耳后注射组及对照组总有效率分别为76.67%和74.19%,显效率分别为36.67%,38.71%,差异无统计学意义。耳后注射组血压及血糖无明显变化。结论　耳后注射甲强龙联合常规药物治疗突发性聋可获得满意疗效。耳后注射甲强龙有可能取代传统静脉激素给药用于突发性聋的治疗。     

Preauricular sinus: Operating microscope improves outcome

A retrospective review of preauricular sinuses operated in Sundaram Medical Foundation, a 140-bedded tertiary care hospital during the period 1995 to 2000 is presented. Patients were operated six to eight weeks after control of infection. Magnification with an operating microscope was always used. A team of ENT and Plastic surgeons was involved in all the cases. Involvement of a Plastic and Reconstructive surgeon permitted primary closure after surgery without any drains, individualised incisions in every patient, and early discharge from hospital. A follow up of all operated patients for a period of 18 months revealed good results without any recurrence.     

Surgical treatment of the infected preauricular sinus

Summary Tissue extract of antrochoanal polyps showed a faint lysis area on standard fibrin plates, but streptokinase (SK)-added tissue extract showed a large lysis area. No fibrinolytic activity was observed on plasminogen-free fibrin plates. It is concluded, therefore, that the fibrinolytic activity observed after SK addition is indicative of the existence of SK-responsive protein proactivator. The tissue extract did not contain plasminogen or antiprotease against trypsin or papain. It was stable at neutral pH at 37° C and stable at acid pH at 70° C. The role of proactivator is discussed in relation to the growth or enlargement of antrochoanal polyps.     

Congenital periauricular fistulas: Possible variants of the preauricular sinus

ObjectiveAlthough most preauricular sinuses are located near the anterior limb of the ascending helix, some are located in unusual areas around the auricle, as shown previously in limited reports. This study analyzed the clinical manifestations of congenital periauricular fistulas with unusual fistula locations and the possible relationship with the classical preauricular sinus.MethodsWe reviewed the medical records of patients who underwent congenital periauricular sinus excision by three surgeons and followed them for more than 6 months. Clinical manifestations were compared between classical preauricular sinus (classical group) and congenital periauricular fistula (variant group) patients.ResultsThe classical and variant groups included 192 and 20 ears each, respectively. In the variant group, the fistula locations were in the ascending helix crus (15 ears, most common), infra-auricular area (3 ears), supra-auricular area (1 ear), and anterior to tragus (1 ear). In ears with fistulas in the ascending helix crus, the fistulous tract most often showed a medial direction (9 ears). There were 4 ears in the variant group with fistulous tracts running toward the postauricular area.ConclusionsCongenital periauricular fistulas can be located anywhere around the auricle, and also considered the variant of preauricular sinus because the whole tracts were limited to lateral side of temporalis muscle and parotid gland as well as not associated with external auditory canal and facial nerve. Among them, the most common variant was a fistula on the ascending helix crus with short fistulous tract directed medially.     

A prospective analysis of incidental paranasal sinus abnormalities on CT head scans

A prospective analysis of the incidence of paranasal sinus opacification in 100 patients referred for cranial computerized tomography (CT) for non-sinus related problems is described. The findings were correlated with symptomatic assessment. Twenty-seven per cent of asymptomatic patients had sinus opacification. The study illustrates the importance of careful clinical correlation when interpreting CT scans of the paranasal sinuses.     

Peripheral giant cell granuloma of the mandibular condyle presenting as a preauricular mass

Preauricular mass is a common symptom for patients presenting to the otorhinolaryngologist with parotid disease. Some rare extraparotid lesions, originating from the temporomandibular joint and the mandible itself, also share the same localization and therefore are to be taken into consideration for the differential diagnosis with parotid lesions. Giant cell granuloma (GCG) was first described by Jaffe in 1953. Peripheral GCG (PGCG) is an exophytic soft tissue lesion originating from the periodontal ligament and periosteum. It is located only within the oral cavity. Central GCG (CGCG) is an uncommon benign fibro-osseous lesion generally presenting as an expansible mass with cortical bone defect. It is generally located in the mandible. The brown tumor of hyperparathyroidism and giant cell tumor must be ruled out because of the microscopic similarities of these lesions. The first case of PGCG of the mandible condyle is presented, and attention is drawn to mandibular diseases for the differential diagnosis of the preauricular mass.     

The preauricular sinus: A review of its aetiology, clinical presentation and management

The preauricular sinus is a not uncommon finding in the paediatric population. Recent reports have added to our knowledge of this benign malformation. We review the current literature with respect to the aetiology of the condition, its clinical features, and associations with other congenital malformations. In those patients in whom a preauricular sinus is identified, we recommend associated congenital anomalies be sought. In selected cases, a renal ultrasound scan may be appropriate. Where no associated abnormalities are identified, and where the preauricular sinus is asymptomatic, there is consensus opinion that no further action is indicated. In the acute phase of infection, treatment comprises administration of appropriate antibiotics, and incision and drainage of an abscess if present. In the symptomatic preauricular sinus exhibiting recurrent or persistent infection, opinion regarding optimal management varies. Latest evidence suggests definitive surgical treatment offering the most favourable outcome is by wide local excision of the sinus, as opposed to the previously preferred technique of simple sinectomy. Magnification employed during surgery, and opening, and following from the inside as well as outside, branching tracts of the sinus may further minimise the risk of recurrence.     

Analysis of incidence and genetic predisposition of preauricular sinus

ObjectivesTo evaluate the incidence of preauricular sinus, the association between preauricular sinus of a parent and their children, and the odds of hearing impairments in patients with preauricular sinus.MethodsA cross-sectional study was performed using data from the Korea National Health and Nutrition Examination Survey. We evaluated data from 23,533 subjects who were interviewed between 2010 and 2012.ResultsThe incidence of unilateral preauricular sinus was 1.3% and that of bilateral preauricular sinus was 0.3%. Female gender was statistically associated with preauricular sinus (adjusted odd ratio, AOR = 1.401). There was no statistical difference between right- and left-sided preauricular sinus. There was an association between parents and their children for bilateral preauricular sinus (AOR of father's bilateral preauricular sinus = 35.711; AOR of mother's bilateral preauricular sinus = 7.683), but there was no association found for unilateral preauricular sinus. There was no link found between hearing impairment and preauricular sinus.ConclusionThis large population-based study provides reliable information about the incidence of preauricular sinus, the association between preauricular sinus in parents and their children, and the lack of an association with hearing impairment; these results can help clinicians in the management of their patients.