eSurgery

Preauricular sinus

What is it?
There is a dimple or pit in the skin in front of the ear. From here a tract heads under the skin. This tract may or may not branch out. Frequently, the tract ends up being infected leading to redness of the overlying skin and a purulent discharge.

Why does it occur?
During foetal development, different parts of the head(called branchial arches) join together. Failure of this may lead to congenital problems such as cleft lip or cleft palate. In a similar fashion, the preauricular tract is due to different parts of the head not fusing together completely during foetal development. Occassionally, there may be other associated anomalies for example in the kidneys.

Treatment

When acutely infected, antibiotics is required. Sometimes if there is an abscess, this requires drainage. If possible, this should be drained by enlarging the pit opening and the tract washed out with Betadiene.

Surgery is the definitive treatment if there has been previous infections. This involves excising the whole tract and is best done in an operating theatre. Often the tract needs to be identified by injecting it with a blue dye. There is significant risk of recurrence with surgery(rates published are as high as 15-40%) – usually this occurs when the tract has branched and the the other tract has not been excised. Sometimes more radical surgery is required to excise out all the tissue in front of the ear to prevent recurrence and this would required a general anaesthesia.

Risks of surgery
Scar
Wound problems – infection, discharge, ooze, redness
Pain
Bleeding, bruising
Nerve damage – the facial nerve lies close
Recurrence