Journal of Research in Medical and Dental Science

2022, Volume 10, Issue 4, Page No: 67-69

Copyright CC BY-NC 4.0
Available Online at: www.jrmds.in
eISSN No. 2347-2367: pISSN No. 2347-2545

Management of Preauricular Sinus

MK Rajasekar, Shwetha Shashikumar*

Department of ENT, Sree Balaji Medical College and Hospital, Shankar Nagar, Chromepet, Chennai, Tamil
Nadu, India

ABSTRACT
Preauricular sinuses are a relatively frequent congenital anomaly. They are, for the most part, asymptomatic. They
are most commonly present on the right side, parallel to the external ear, near to the anterior margin of the ascending
limb of the helix. Preauricular sinuses can be inherited or develop on their own. They are inherited in an incomplete
Autosomal dominant manner. It's probable that 25–50% of cases are bilateral, which increases the likelihood of
inheritance. Preauricular sinuses are linked to various illnesses or syndromes in 3–10% of cases, including deafness
and branchiootorenal (BOR) syndrome. If there are any congenital anomalies in these sinuses, an audiologist should
be consulted and a renal ultrasound should be performed.
Key words: Preauricular sinus, Pregnancy, Branchial arch

HOW TO CITE THIS ARTICLE: MK Rajasekar, Shwetha Shashikumar, Management of Preauricular Sinus, J Res Med Dent Sci, 2022, 10 (4):67-
69.

Corresponding author: Shwetha Shashikumar

e-mail: [email protected]
Received: 30-Mar-2022, Manuscript No. JRMDS-22-58987;
Editor assigned: 01-April-2022, Pre QC No. JRMDS-22-58987 (PQ);
Reviewed: 18-April-2022, QC No. JRMDS-22-58987;
Revised: 21-April-2022, Manuscript No. JRMDS-22-58987 (R);
Published: 28-April-2022

INTRODUCTION

During the sixth week of pregnancy, the Hillocks of

His are six mesenchymal proliferations that develop
the auricle: three from the caudal border of the first Figure 1: Development of auricle from hillock of his.

branchial arch and three from the cephalic border of

the second branchial arch. The auricle is formed as they
fuse together. The most commonly stated and accepted
idea is that a preauricular sinus develops as a result of
an incomplete or imperfect union of the six auditory
hillocks during auricle development. Incomplete fusing
of the hillocks results in a blind-ended sinus. The sinus
is lined with skin, which can lead to recurrent discharge
and infections. While a sinus located above the tragus
line is normally an independent preauricular sinus/
cyst, a sinus found below the tragus line is more likely
associated to a first branchial cleft abnormality, and
testing for a fistula in the external auditory canal is
essential [1-5]. The developmental structure of the Figure 2: Preauricular sinus.
auricle from hillock of his is depicted in Figure 1.
sinus is shown in Figure 2.
The condition can be sporadic or genetic, and it is
more common in women. Over half of all instances are CASE HISTORY
unilateral, with the remaining half being sporadic. In
situations of bilateral preauricular sinus, incomplete 9 We dealt with five cases of preauricular sinusitis.
autosomal dominance with lower penetrance is more Patients with periodic discharge from the
likely to beinherited (nearly 85 percent) 4. Preauricular preauricular region presented to the ENT OPD.

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Vaishali K. J Res Med Dent Sci, 2022, 10 (4):67-69

9 Despite the fact that the majority of patients were DISCUSSION

clinically silent, indicators of an infectious process
are not uncommon. Erythema, swelling, pain, and A little pit on the anterior side of the ascending part of
discharge were some of the presenting signs and the helix, surrounding the postero superior boundary
symptoms. of the helix, the tragus, or the lobule, is the preauricular
sinus. The sinus does not always follow the same course
9 If the outcome was isolated and asymptomatic, no in subcutaneous tissues. It's possible that the visible pit
therapy was necessary. Only patients with infected is the entire malformation, or that it's a sinus tract that
sinuses were treated. In the acute stage of infection, varies in length, forks, and follows a complex path. In all
adequate antibiotics were administered; when cases, a piece of the tract fuses with the perichondrium
an abscess was evident, an incision and drainage of the auricular cartilage. An infected preauricular sinus
procedure was performed. can cause erythema, edema, pain, and discharge, even
9 No particular investigation was performed apart if it is clinically silent. The most prevalent pathogens
from routine tests for general anaesthesia. that cause infection are Staphylococcal species, as well
as Proteus, Streptococcus, and Peptococcus species.
9 In the case of recurring or chronic preauricular Preauricular sinuses can be inherited or develop on
sinus infection, surgical removal of the sinus and its their own. Mutations in the EYA1 gene on chromosome
tract during a period of quiescence may be required. 8q13 have been detected in 40% of patients. Branchio-
9 Incomplete excision is the cause of recurrence. oto-renal syndrome is a genetic disorder characterized
by outer, middle, and inner ear developmental problems,
9 A basic sinectomy consists of removing an oval patch branchial cleft anomalies, and renal abnormalities [6-8].
of skin around the sinus entrance and dissecting
out the sinus tract which is shown in Figures 3 and Preauricular sinus excision
Figure 4.
9 In all cases, general anaesthesia was administered.
9 Incision: An elliptical incision was made around the
sinus pit and continued superiorly and posteriorly
into the post aural sulcus (Figures 5 and Figure 6).
The temporalis fascia serves as the dissection’s medial
boundary, while the anterior helix cartilage serves as
the dissection’s posterior margin. Using a self-retaining
mastoid retractor to retract tissues has shown to be
incredibly effective. The preauricular sinus, as well as
the tissue above the temporalis fascia, is excised (Figure 7).
9 A portion of the helix’s cartilage or perichondrium
is excised at the base of the sinus, implying that the
epithelial lining is entirely removed in all cases.

Figure 3: Case 1 showing bilateral preauricular sinus preop and

postop images.

Figure 5: Injecting methylene blue to visualize preauricular sinus

tract.

Fgire 4: Case 2 showing infected preauricular sinus preop and

posto images. Figure 6: Elliptical incision around sinus.

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in tissues, making it difficult to detect the tiniest

ramifications. Fistulography is conducted in the absence
of acute viral infections and requires expert hands. There
is an approximate estimate of the sinus length, but no
indication of its depth. The absence of surgical radicality
and, as a result, the high recurrence rate is most likely
due to these issues 8.
Furthermore, the type of anaesthetic used has been
shown to influence the rate of recurrence. When surgery
Figure 7: Dissection. was performed under general anaesthetic, there was no
recurrence. Individual preference currently determines
9 The layered closing reduces dead space. which of these approaches is used, but wide local
9 The skin is sutured with 3′O silk or prolene suture. excision in a Supra Auricular approach under general
The drain should be left in place if the incision is anaesthesia using an Extended Post Auricular incision
stretched halfway through the post-aural area; would almost certainly produce satisfactory results, and
otherwise, the wound should be closed. many of the variations mentioned in the literature are
unwarranted. This is a pretty simple method that does
9 After 24 hours, the dressing was removed along not require much coaching.
with the drain.
9 Patients are given antibiotics and anti-inflammatory REFERENCES
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methylene blue injections during surgery, and the use of preauricular fistula maps to chromosome 8q11. 1–q13.
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