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Chen J, Zhou P, Zuo J, Ming W, Huang T, Tao Z. Variant Types of Preauricular Sinuses: Classifications, Clinical Presentation and Management. Laryngoscope 2024. [PMID: 38466172 DOI: 10.1002/lary.31378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/21/2024] [Accepted: 02/21/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To make surgeons aware of the differing types of preauricular sinuses (PAS), we summarize our experience with diagnosis and treatment of varying types of PAS. METHODS We retrospectively reviewed clinical data from patients who had undergone preauricular fistulectomy between March 2015 and March 2020. These patients were categorized into two groups according to locations of congenital fistula pit. RESULTS Twelve patients with variant PAS accounted for 6.8% (12/177) of all patients. The variant types of PAS could be classified into three types (from type 1 to type 3), based on the location of the fistula pit. Type 1 (seven patients; eight ears) patients had pits located on the ascending helix crus, whereas type 2 (four patients, four ears) and type 3 (one patient, one ear) patients had pits located on the external auditory canal (EAC) and lobule, respectively. Fistular tracts penetrated the cartilage of the helix crus in seven of the type 1 variant ears. Swelling and discharge were located at the ascending helix crus (in four ears), cavum concha (in two ears), and posterior to the auricle (in one ear). In four of the type 2 ears, the fistular tracts were located at the anterior margin of the ascending limb of the helix. CONCLUSION Fistula tracts where fistula pit occurred on the ascending helix crus were more likely to penetrates through the cartilage, and fistula tracts with fistula pits that occurred on the EAC were adjacent to the cartilage of the ascending helix and tragus. Meticulous dissection and complete removal of fistula tissue are critical to avoid postoperative recurrence. LEVEL OF EVIDENCE Level 4. Laryngoscope, 2024.
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Affiliation(s)
- Jinhui Chen
- The Department of Otolaryngology, Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ping Zhou
- The Department of Otolaryngology, Yixing People's Hospital of Jiangsu University, People's Hospital of Yixing City, Yixing, China
| | - Jingjing Zuo
- The Department of Otolaryngology, Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wei Ming
- The Department of Otolaryngology, Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ting Huang
- The Department of Otolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zezhang Tao
- The Department of Otolaryngology, Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
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Yuan L, Yang R, Deng H. Auricular fistula: a review of its clinical manifestations, genetics, and treatments. J Mol Med (Berl) 2023; 101:1041-1058. [PMID: 37458758 DOI: 10.1007/s00109-023-02343-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 09/07/2023]
Abstract
Auricular fistula is a common congenital auricular malformation, characterized as a small opening in the skin and a subcutaneous cyst. It can be classified in different ways according to positions of pits and directions of fistula tracts. The term preauricular fistula and variant type of preauricular fistula (postauricular fistula) are used. Auricular fistula prevalence varies in countries and populations, and its actual prevalence is presently unknown. The most accepted and widely cited theory of auricular fistula etiopathogenesis is an incorrect or incomplete fusion of six auricular hillocks that are mesenchymal proliferations. Auricular fistula can occur either sporadically or genetically. The pattern in inherited cases is thought to be incomplete autosomal dominant, with variable expressions, reduced penetrance, and inapparent gender differences. Auricular fistula has several forms and is reported as being a component of many syndromes. In the field of genetics, currently, there is no related review to comprehensively summarize the genetic basis of auricular fistula and related disorders. This article provides a comprehensive review of auricular fistula, especially congenital preauricular fistula, which accounts for the majority of auricular fistula, by summarizing the clinical manifestations, histological and embryological development, genetics, examinations, and treatments, as well as syndromes with auricular fistula.
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Affiliation(s)
- Lamei Yuan
- Health Management Center, the Third Xiangya Hospital, Central South University, Changsha, 410013, China
- Center for Experimental Medicine, the Third Xiangya Hospital, Central South University, Changsha, 410013, China
- Disease Genome Research Center, Central South University, Changsha, 410013, China
- Department of Neurology, the Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Ruikang Yang
- Health Management Center, the Third Xiangya Hospital, Central South University, Changsha, 410013, China
- Center for Experimental Medicine, the Third Xiangya Hospital, Central South University, Changsha, 410013, China
- Disease Genome Research Center, Central South University, Changsha, 410013, China
| | - Hao Deng
- Health Management Center, the Third Xiangya Hospital, Central South University, Changsha, 410013, China.
- Center for Experimental Medicine, the Third Xiangya Hospital, Central South University, Changsha, 410013, China.
- Disease Genome Research Center, Central South University, Changsha, 410013, China.
- Department of Neurology, the Third Xiangya Hospital, Central South University, Changsha, 410013, China.
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Xu B, Bi J, Yu B, Yu L, Fu Y. Clinical features, diagnosis, and treatment of different types of congenital preauricular fistulas in pediatric patients. Int J Pediatr Otorhinolaryngol 2023; 170:111599. [PMID: 37196371 DOI: 10.1016/j.ijporl.2023.111599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/19/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE The aim of this study was to summarize the clinical features of congenital preauricular fistula (CPF) in pediatric patients to improve the levels of diagnosis and treatment, reduce the rates of missed diagnosis and recurrence, and shorten the total diagnosis and treatment time. METHODS A total of 353 patients with CPF who were admitted to the Department of Otolaryngology in The Children's Hospital, Zhejiang University School of Medicine between January 2019 and December 2021 was enrolled in this retrospective observational study. Follow ups for 12-42 months were performed to investigate the classification, surgical methods, and postoperative conditions of CPF and to compare the recurrence rate, complication rate, and total diagnosis and treatment time between the active infection CPF group (AICPFG) and infection-controlled/non-infected CPF group (IC/NICPFG). RESULTS In 316 cases (89.5%) out of the 353 patients, the natural fistula orifice was located in front of the crus helicis; in 33 cases (9.4%), the natura fistula orifice was located at the crus helicis; and in 4 cases (1.1%), the natura fistula orifice was located in the external acoustic meatus. The AICPFG had 52 cases (14.7%), including 1 case (0.28%) of recurrence and 2 cases (0.56%) of infection at the incision site. The IC/NICPFG had 301 cases (85.3%), including 4 cases (1.13%) of recurrence, 6 cases (1.7%) of infection at the incision site, and 1 case (0.28%) of scar formation at the incision site. There were no significant differences in the recurrence rates and postoperative complications between the AICPFG and IC/NICPFG (p > 0.05). There was a statistically significant difference in the total diagnosis and treatment time between the AICPFG and IC/NICPFG (p < 0.05). CONCLUSION A reasonable classification of CPF, use of appropriate surgical methods, and belonging to the AICPFG do not increase the recurrence and complication rates of children but shorten the total treatment course, relieve patients' suffering, reduce treatment costs, and achieve a better clinical prognosis.
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Affiliation(s)
- Bin Xu
- Department of ENT and Head and Neck Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
| | - Jin Bi
- Department of ENT and Head and Neck Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
| | - Bo Yu
- Department of ENT and Head and Neck Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
| | - Lulu Yu
- Department of ENT and Head and Neck Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
| | - Yong Fu
- Department of ENT and Head and Neck Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
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Yadav S, Kaur T, Singla V. Rhomboid Flap Reconstruction for Type 1 Postauricular Variant of Preauricular Sinus. Indian J Otolaryngol Head Neck Surg 2023; 75:393-395. [PMID: 37206768 PMCID: PMC10188853 DOI: 10.1007/s12070-023-03501-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 01/16/2023] [Indexed: 02/03/2023] Open
Abstract
Preauricular sinuses are common congenital malformations in paediatric patients. We describe a case of preauricular sinus with postauricular extension, a "variant type" of pre-auricular sinus and its management. After control of infection with antibiotics, the sinus was excised in toto using bidirectional approach. The sinus tract along with rim of conchal cartilage and post auricular skin was excised. The defect was reconstructed using retroauricular rhomboid flap. At one month follow up, the post-operative wound showed no signs of infection, minimal scar formation and had satisfactory aesthetic outcome. This reconstruction technique can be considered in cases of defects in posterior pinna.
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Affiliation(s)
- Sanjeev Yadav
- Department of Otorhinolaryngology, Dr. B.R. Ambedkar State Institute of Medical Sciences, Mohali, India
| | - Taranjot Kaur
- Department of Otorhinolaryngology, Dr. B.R. Ambedkar State Institute of Medical Sciences, Mohali, India
| | - Vikram Singla
- Department of Otorhinolaryngology, Govt. Multi Speciality Hospital, Sector 16, Chandigarh, India
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Jiang Y, He T, Liu W. Resecting the Lesion Combined with Local Flap Repairing for the Treatment of Infected Congenital Preauricular Fistula. Int J Gen Med 2021; 14:7285-7292. [PMID: 34737622 PMCID: PMC8560080 DOI: 10.2147/ijgm.s331698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/15/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Evaluating the treatment of infected preauricular fistulas by resecting the lesion combining with local flap repairing. Patients and Methods This clinical study was implemented in Ningbo No. 1 Hospital and Wuhan No. 1 Hospital of China. We included 100 cases who were diagnosed with infected preauricular fistulas and needed further surgery treatment. Among them, 50 patients experienced the conventional treatment including a fully infection control following with a surgery to remove preauricular fistulas (conventional treatment group). Other 50 patients only took some simple pre-operation treatment for about 1-7 days, and then preauricular fistulas resection combining local flap repairing were performed regardless of the infection (local flap repairing group). The duration of total treatment procedure, healing index, and total cost were observed. Results All patients were discharged at about 7 days after surgery, the duration of the post-operative period had no significant difference between groups. The total duration of treatment (from any first treatment time point to patient discharge) was only 13.98±2.14 days in the local flap treatment group compared with that of 43.06±8.24 days in the conventional treatment group. Further, the total cost of treatment per patient in the local flap repairing treatment group was about 47.1% of that in the conventional treatment group. Conclusion For the treatment of infected preauricular fistula, performing a lesion removing surgery combining a local flap repairing can shorten the total treatment course, relieve patient's suffering, reduce treatment cost, and achieve a better clinical prognosis.
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Affiliation(s)
- Yuanming Jiang
- Department of Otolaryngology, Wuhan No. 1 Hospital, Wuhan, Hubei, 430022, People's Republic of China
| | - Ting He
- Department of Otolaryngology, Wuhan No. 1 Hospital, Wuhan, Hubei, 430022, People's Republic of China
| | - Wei Liu
- Department of Otolaryngology, Wuhan No. 1 Hospital, Wuhan, Hubei, 430022, People's Republic of China
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