Decision making in the choice of surgical management for preauricular sinuses with different severities.

OBJECTIVES: The preauricular sinus is a common congenital abnormality of the preauricular soft tissues. Here, we demonstrate the decision making in the choice of surgical management of preauricular sinuses based on disease severity. In addition, a method termed figure 8 incision with extended fistulectomy is introduced.

STUDY DESIGN: Case series with chart review.

SETTING: Tertiary care center.

SUBJECTS: Between January 2003 and February 2010, a total of 90 patients (109 ears) underwent surgery for preauricular sinuses in our hospital.

METHODS: After controlling the infection, the patients received definite surgery. They were classified into 3 groups according to the operative methods. We recorded the clinical conditions and any recurrences during the follow-up period.

RESULTS: Group I patients (48 ears) had a trace inflammatory condition and underwent a simple sinusectomy. The recurrence rate was 2.08%. Group II (31 ears) and group III (30 ears) patients had more highly inflamed tissue and underwent a local wide excision and a figure 8 incision with extended fistulectomy, respectively. The recurrence rate in group II was 22.58%. Meanwhile, none of the group III cases showed a recurrence. In our study, there were 8 recurrent cases in 109 ears, yielding a recurrence rate of 7.34%.

CONCLUSION: Simple sinusectomy is an adequate surgical technique for preauricular sinuses with a mild inflammatory condition. For more severe cases, the figure 8 incision with extended fistulectomy can achieve adequate wound exposure for radical excision of the inflamed tissue and a satisfactory surgical outcome.