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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