Surgical results of infected preauricular sinus: No need for delay

Surgical technique for complicated preauricular sinus: Pilot study of double elliptical excision with coaptation suture

OBJECTIVES

Preauricular sinus (PAS) is a congenital anomaly that can progress to complicated cases with granulation tissue around the PAS area due to skin inflammation. Treatment involves incision and drainage or continuous dressing; however, surgical treatment may be necessary. We evaluated a surgical method for the effective treatment of complicated PAS.

MATERIALS AND METHODS

We retrospectively reviewed the medical records of 152 patients with PAS who were treated at a tertiary medical institution between September 2015 and June 2022. Data regarding age, sex, preoperative history related to PAS, a joint operation with a plastic surgeon, operation time, admission duration, follow-up duration, and postoperative complications were collected. The study population was divided into single-excision and double-excision with coaptation suture groups. The clinical characteristics were analyzed and compared between the two groups.

RESULTS

Surgical treatment for PAS was performed in 131 patients (166 ears) in the single-excision group and 21 patients (27 ears) in the double-excision group. The average age was 6.22 ± 4.06 years old, and the male-to-female ratio was similar in the single-excision group (M:F = 68:63) but higher for females in the double-excision group (M:F = 5:16) (p = 0.017). Joint surgeries with a plastic surgeon were more frequent in the double-excision group, and the operation time and admission duration were significantly longer. The preoperative history and postoperative complications (seven cases, 4.6 %) did not differ significantly between the two groups, although there was a higher percentage of complications in the double elliptical excision group.

CONCLUSIONS

Double excision with one or more coaptation sutures is an effective one-step method for complicated PAS with an acceptable aesthetic appearance of the scar, although it requires a longer operation time and admission duration for wound care. Further studies with larger and more diverse patient populations are needed to validate these findings.

Standardized surgical strategy for the treatment of preauricular sinus to reduce recurrence

BACKGROUND

Preauricular sinus (PAS) is a common congenital anomaly, and complete excision is recommended to prevent recurrence. However, PAS has a high recurrence rate as a result of incomplete removal due to the high variability of the sinus ramifications, making its treatment challenging. In this study, we standardized the surgical procedure to reduce the complications and recurrence rate and compared the postoperative results between the non-standardized and the standardized groups.

METHODS

This retrospective study included 97 patients (120 ears) who had undergone PAS excision by a single surgeon between October 2014 and September 2022 and underwent at least 6 months of follow-up. After October 2018, all patients were treated using the standardized method, which comprised the use of magnifying glasses, exploration with a lacrimal probe, the use of methylene blue staining, and excision of a piece of surrounding normal tissue and related cartilage in continuity with the specimen. There were 38 patients (45 ears) in the non-standardized group and 59 patients (75 ears) in the standardized group.

RESULTS

Recurrence was observed in six of 120 ears, indicating an overall recurrence rate of 5.0%. Recurrence occurred in five ears (11.1%) in the non-standardized group and one ear (1.3%) in the standardized group. The standardized group had a significantly lower recurrence rate (p= 0.027) than the non-standardized group.

CONCLUSION

We defined a standardized sinectomy protocol and used it for the surgical treatment of PAS. With this standardized method, we were able to reduce the rates of complications and recurrence without the use of a long incision.

Surgical treatment of preauricular fistulas: a 12-year single-center clinical observation

OBJECTIVE

This study aimed to assess the effects of surgical timing and approach on operative duration, postoperative suture removal time, and postoperative recurrence rate in the management of preauricular fistula. A 12-year single-center clinical observation was conducted to analyze the potential effects of different surgical strategies on these critical outcomes.

METHODS

The clinical data from 576 (782 ears) patients who underwent surgical resection for preauricular fistulas were examined in this retrospective study. The patients were classified into various groups based on differences in operative duration, surgical techniques and the use of intraoperative magnifying equipment. Furthermore, the specific data on operative duration, postoperative suture removal time, and postoperative recurrence rate were also recorded.

RESULTS

The average operative duration for 782 ears and the average time required for postoperative suture removal were determined to be (34.57 ± 4.25) min and (3.62 ± 0.76) days, respectively. Among the cases examined, recurrence occurred in 13 ears, but all of them were cured after a second surgery, resulting in a recurrence rate of 1.67% (13/782). Interestingly, the operative and postoperative suture removal time was prolonged during the infection period (P < 0.05). The postoperative recurrence rate was significantly higher in the absence of magnifying equipment, as compared to those with the use of a microscope with 2.5× magnification (P < 0.05). No statistically significant differences were noted in the recurrence rate when comparing different anesthesia methods and types of surgical incisions, as well as the intraoperative use of methylene blue, and partial removal of cartilage of the pedicle (P > 0.05).

CONCLUSION

The use of methylene blue, partial removal of the cartilage of the pedicle, and surgical incision during preauricular fistula resection did not affect the operative duration, postoperative suture removal time, and postoperative recurrence rate. Therefore, surgeons can select their preferred approaches based on their individual practices and patient-specific situations. However, the use of magnifying equipment during surgery is associated with a reduced risk of recurrence.

Clinical features, diagnosis, and treatment of different types of congenital preauricular fistulas in pediatric patients

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.

Resecting the Lesion Combined with Local Flap Repairing for the Treatment of Infected Congenital Preauricular Fistula

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.

Surgical treatment of preauricular sinus in children: Temporalis muscle fascia anchoring suture

OBJECTIVE

The aim of this study was to find an effective treatment method for preauricular sinus (PAS) in the pediatric population. We also investigated if the prognosis of treatment differed according to the location of the PAS.

METHODS

From May 2015 to April 2020, a retrospective chart review was conducted on pediatric patients who underwent surgical excision of PAS at a tertiary referral medical center. Patients were divided into classical and variant groups according to the location of the PAS. The recurrence and postoperative complications, along with the preoperative history, were confirmed through medical chart review.

RESULTS

A total of 88 patients (112 ears) were included in the study (n = 77 in the classical group and n = 11 in the variant group). The mean age of the patient was 6.5 years, and there were 48 males and 40 females. To reduce recurrence after surgical treatment, a temporalis muscle fascia anchoring suture was used in combination with preoperative pit dye staining, probe use, and surgical microscopy. The overall recurrence rate was 2.4% (2 cases), and postoperative minor complications were chronic pain (4.5%, n = 4), minor skin inflammation (10.2%, n = 9), and subcutaneous suture knot discomfort (13.6%, n = 12). Between the classical and variant groups, no clinical differences such as recurrence rate or complication rate were found, except for the long hospitalization period in the variant group (p = 0.043).

CONCLUSIONS

The use of a temporalis muscle fascia anchoring suture in combination with pit dye staining, probe use, and surgical microscopy in pediatric patients with PAS showed relatively low recurrence and complication rates compared to what has been previously reported in the literature. PAS in the variant position did not affect prognosis.