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Preauricular Sinus

Here’s an overview of preauricular sinus.

A preauricular sinus is a congenital anomaly characterized by a small pit or opening in the skin near the external ear, typically in front of the ear (preauricular area).

Epidemiology

  • 1. Prevalence:

    Preauricular sinuses are relatively rare, occurring in about 0.1-0.9% of the population.

  • 2. Bilateral involvement:

    Some cases may involve both ears.

Pathophysiology

  • 1. Incomplete fusion:

    Preauricular sinuses are thought to result from the incomplete fusion of the auricular hillocks during embryonic development.

  • 2. Epithelial-lined tract:

    The sinus tract is lined with epithelium, which can lead to the accumulation of debris and potential infection.

Embryology

  • 1. Auricular development:

    The external ear develops from six auricular hillocks, which fuse to form the ear.

  • 2. Abnormal development:

    Incomplete fusion or abnormal development of these hillocks can lead to preauricular sinuses.

Symptoms and Signs

  • 1. Asymptomatic:

    Many preauricular sinuses are asymptomatic and may go unnoticed.

  • 2. Discharge or infection:

    Some cases may present with discharge, swelling, or infection in the affected area.

  • 3. Bilateral:

    Bilateral involvement (affecting both ears) occurs in approximately 25-50% of cases. However, the exact percentage can vary depending on the population being studied.

Complications

  • 1. Infection:

    Preauricular sinuses can become infected, leading to abscesses or cellulitis.

  • 2. Recurrent infections:

    Some cases may experience recurrent infections.

Investigations

The investigations typically include the following:

  • 1. Clinical examination:

    Diagnosis is often made based on clinical examination and history.

  • 2. Imaging:

    Imaging studies, such as ultrasound or CT scans, may be used to evaluate the extent of the sinus tract.

Step-by-Step Operative Management

  • 1. Preoperative evaluation:

    Evaluate the patient for any signs of infection or other complications.

  • 2. Surgical excision:

    The sinus tract is excised, and the surrounding tissue is dissected to ensure complete removal.

  • 3. Wound closure:

    The wound is closed, and the area is dressed to promote healing.

  • 4. Postoperative care:

    The patient is monitored for any signs of complications, such as infection or wound breakdown.

Postoperative Complications

  • 1. Wound infection:

    Infection of the wound can occur after surgery.

  • 2. Recurrence:

    There is a risk of recurrence if the sinus tract is not completely excised.

The goal of surgical management is to completely excise the sinus tract and prevent future complications.

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