Preauricular sinus and cyst

A preauricular sinus is a common congenital malformation characterized by a nodule, dent or dimple located anywhere adjacent to the external ear.[3] Frequency of preauricular sinus differs depending the population: 0.1–0.9% in the US, 0.9% in the UK, and 4–10% in Asia and parts of Africa.[4]

Preauricular sinus and cyst
Other namesCongenital auricular fistula, Geswein Hole, Congenital preauricular fistula, Ear pit,[1]:782 or a Preauricular cyst[2]
Preauricular sinus on right ear
SpecialtyOtorhinolaryngology 

Preauricular sinuses are inherited features, and most often appear unilaterally. They are present bilaterally in 25–50% of cases.

Presentation

Complications

Occasionally a preauricular sinus or cyst can become infected.[5] Most preauricular sinuses are asymptomatic, and remain untreated unless they become infected too often.[6] Preauricular sinuses can be excised surgically, but often present a high risk of recurrence.[7]

Causes

Preauricular sinuses and cysts result from developmental defects of the first and second pharyngeal arches.[8] This and other ear malformations are sometimes associated with renal anomalies.[9] In rare circumstances these pits may be seen in genetic conditions such as branchio-oto-renal syndrome; however these conditions are always concurrent with other health concerns.[10]

Treatment

Courses of treatment typically include the following:

  • Draining the pus occasionally as it can build up a strong odor
  • Antibiotics when infection occurs.
  • Surgical excision is indicated with recurrent fistular infections, preferably after significant healing of the infection. In case of a persistent infection, infection drainage is performed during the excision operation. The operation is generally performed by an appropriately trained specialist surgeon e.g. an otolaryngologist or a specialist General Surgeon.
  • The fistula can be excised as a cosmetic operation even though no infection appeared. The procedure is considered an elective operation in the absence of any associated complications.

See also

References
  1. Freedberg IM, Fitzpatrick TB (2003). Fitzpatrick's Dermatology in General Medicine (6th ed.). McGraw-Hill. ISBN 978-0-07-138076-8.
  2. Rapini RP, Bolognia JL, Jorizzo JL (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.
  3. Scheinfeld NS, Nozad V (18 March 2008). "Preauricular Sinuses". MedScape. Retrieved 24 February 2009.
  4. Kim HJ, Lee JH, Cho HS, Moon IS (September 2012). "A case of bilateral postauricular sinuses". Korean Journal of Audiology. 16 (2): 99–101. doi:10.7874/kja.2012.16.2.99. PMC 3936561. PMID 24653881.
  5. James WD, Berger TG, et al. (2006). Andrews' Diseases of the Skin: Clinical Dermatology. Saunders Elsevier. ISBN 978-0-7216-2921-6.
  6. Ludwig S, Strobel S, Marks SD, Smith PK, El Habbal MH, Spitz L (2008). Visual Handbook of Pediatrics and Child Health. Lippincott Williams & Wilkins. p. 517. ISBN 978-0-7817-9505-0.
  7. Leopardi G, Chiarella G, Conti S, Cassandro E (December 2008). "Surgical treatment of recurring preauricular sinus: supra-auricular approach". Acta Otorhinolaryngologica Italica. 28 (6): 302–5. PMC 2689545. PMID 19205595.
  8. "Preauricular Sinus". Stedman's Medical Spellchecker. 2006. Retrieved 24 Feb 2009. cited in WrongDiagnosis.com
  9. Wang RY, Earl DL, Ruder RO, Graham JM (August 2001). "Syndromic ear anomalies and renal ultrasounds". Pediatrics. 108 (2): E32. doi:10.1542/peds.108.2.e32. PMID 11483842.
  10. "Branchiootorenal syndrome". Genetic and Rare Diseases Information Center (GARD).

Bibliography

Further reading
  • Tan T, Constantinides H, Mitchell TE (November 2005). "The preauricular sinus: A review of its aetiology, clinical presentation and management". International Journal of Pediatric Otorhinolaryngology. 69 (11): 1469–74. doi:10.1016/j.ijporl.2005.07.008. PMID 16125253.
Classification
External resources
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