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Comprehensive management of infected preauricular sinuses/cysts.

OBJECTIVE: To review a single-surgeon, 16-year experience with the management of infected preauricular sinuses/cysts.

METHODS: Computerized search of all office notes and operative reports during the years 2002-2018.

SETTING: Academic medical center and suburban office practice.

PARTICIPANTS: Children from 0 to 18 years of age with symptomatic preauricular sinuses/cysts.

INTERVENTION: Children with symptomatic preauricular sinuses/cysts underwent surgical excision. Those presenting with infected cysts were treated with oral antibiotics, needle-aspiration and/or incision and drainage to control infection prior to surgery. The chronic preauricular abscesses were curetted without resection of overlying skin or the abscess walls.

MAIN OUTCOME MEASURE: Control of infection without recurrence following surgery.

RESULTS: 415 patient encounters involved preauricular sinuses/cysts. These ultimately led to 56 surgical excisions. 28 of the sinuses/cysts were infected at presentation. All infected lesions were treated with oral antibiotics. 6 infected sinuses/cysts were needle aspirated. 2 infected sinuses/cysts required incision and drainage. 1 infected sinus/cyst could not be controlled by either drainage technique and was surgically excised while actively infected. Nine children presented with chronic preauricular abscesses. One the 28 infected sinuses/cysts (3.5%) recurred 10 years after surgery- it was cured with re-resection at the root of the helix.

CONCLUSION: Treatment of infected preauricular sinuses/cysts remains controversial. Control of infection prior to definitive surgery is desirable, but not mandatory. Chronic preauricular abscesses can be managed by sinus/cyst excision and subcutaneous abscess curettage without resection of the abscess wall or overlying skin. This leads to consistent control and favorable cosmesis.

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