eMedicine Specialties > Dermatology > Pediatric Diseases

Preauricular Sinuses: Differential Diagnoses & Workup

Author: Noah S Scheinfeld, MD, JD, FAAD, Assistant Clinical Professor, Department of Dermatology, Columbia University; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Private Practice
Coauthor(s): Valerie Nozad, DO, Staff Physician, Beth Israel Medical Center, Department of Internal Medicine, University Hospital for the Albert Einstein College of Medicine; Jeffrey Weinberg, MD, Director, Clinical Research Center, Department of Dermatology, St Luke's; Assistant Clinical Professor, Department of Dermatology, Columbia University College
Contributor Information and Disclosures

Updated: Mar 18, 2008

Differential Diagnoses

Basal Cell Carcinoma
Epidermal Inclusion Cyst

Other Problems to Be Considered

Branchial cleft sinus
Cysts forming from the first pharyngeal pouch abscess
Ulceration on the face

Workup

Laboratory Studies

  • If exudate from the sinus is present, culturing should be performed so that antibiotic therapy tailored to the offending pathogen can be instituted.
  • In 2002, Martin-Granizo et al4 suggested that initial fistula probing serves as a surgical guide and further methylene blue infection helps to avoid leaving viable squamous epithelial remnants.

Imaging Studies

  • Ultrasonography readily depicts preauricular sinuses and demonstrates their relationship to the superficial temporal artery, the anterior crus of the helix, and the tragus.

Histologic Findings

Upon gross examination, the preauricular sinuses are seen to consist of tubular structures of simple or arborized patterns having walls, which may be thin and glistening or white and thickened. The sinus tract may arborize and can be tortuous, and the lumen is filled with debris. The preauricular sinuses are often full of keratin and are surrounded by dense connective tissue.

Microscopically, the duct of the sinus is lined with stratified squamous epithelium and contains many cysts along its tract. The connective tissue surrounding the duct may contain hair follicles; sebaceous and sweat glands; and inflammatory tissue, such as lymphocytes, plasma cells, and polymorphonuclear leukocytes.

More on Preauricular Sinuses

Overview: Preauricular Sinuses
Differential Diagnoses & Workup: Preauricular Sinuses
Treatment & Medication: Preauricular Sinuses
Follow-up: Preauricular Sinuses
Multimedia: Preauricular Sinuses
References
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References

  1. Wang R, Martínez-Frías ML, Graham JM Jr. Infants of diabetic mothers are at increased risk for the oculo-auriculo-vertebral sequence: A case-based and case-control approach. J Pediatr. Nov 2002;141(5):611-7. [Medline].

  2. Saltzmann RM, Lissner GS. Familial absence of lacrimal puncta associated with preauricular sinuses. J Pediatr Ophthalmol Strabismus. Jul-Aug 2006;43(4):233-5. [Medline].

  3. Choi SJ, Choung YH, Park K, Bae J, Park HY. The variant type of preauricular sinus: postauricular sinus. Laryngoscope. Oct 2007;117(10):1798-802. [Medline].

  4. Martin-Granizo R, Pérez-Herrero MC, Sánchez-Cuéllar A. Methylene blue staining and probing for fistula resection: application in a case of bilateral congenital preauricular fistulas. Int J Oral Maxillofac Surg. Aug 2002;31(4):439-41. [Medline].

  5. Tan T, Constantinides H, Mitchell TE. The preauricular sinus: A review of its aetiology, clinical presentation and management. Int J Pediatr Otorhinolaryngol. Nov 2005;69(11):1469-74. [Medline].

  6. Chang PH, Wu CM. An insidious preauricular sinus presenting as an infected postauricular cyst. Int J Clin Pract. Mar 2005;59(3):370-2. [Medline].

  7. Yeo SW, Jun BC, Park SN, Lee JH, Song CE, Chang KH, et al. The preauricular sinus: factors contributing to recurrence after surgery. Am J Otolaryngol. Nov-Dec 2006;27(6):396-400. [Medline].

  8. Tang IP, Shashinder S, Kuljit S, Gopala KG. Outcome of patients presenting with preauricular sinus in a tertiary centre--a five year experience. Med J Malaysia. Mar 2007;62(1):53-5. [Medline].

  9. Baatenburg de Jong RJ. A new surgical technique for treatment of preauricular sinus. Surgery. May 2005;137(5):567-70. [Medline].

  10. Chami RG, Apesos J. Treatment of asymptomatic preauricular sinuses: challenging conventional wisdom. Ann Plast Surg. Nov 1989;23(5):406-11. [Medline].

  11. Coatesworth AP, Patmore H, Jose J. Management of an infected preauricular sinus, using a lacrimal probe. J Laryngol Otol. Dec 2003;117(12):983-4. [Medline].

  12. Currie AR, King WW, Vlantis AC, Li AK. Pitfalls in the management of preauricular sinuses. Br J Surg. Dec 1996;83(12):1722-4. [Medline].

  13. Lam HC, Soo G, Wormald PJ, Van Hasselt CA. Excision of the preauricular sinus: a comparison of two surgical techniques. Laryngoscope. Feb 2001;111(2):317-9. [Medline].

  14. Leung AK, Robson WL. Association of preauricular sinuses and renal anomalies. Urology. Sep 1992;40(3):259-61. [Medline].

  15. O'Mara W, Guarisco L. Management of the preauricular sinus. J La State Med Soc. Sep 1999;151(9):447-50. [Medline].

  16. Scheinfeld NS, Silverberg NB, Weinberg JM, Nozad V. The preauricular sinus: a review of its clinical presentation, treatment, and associations. Pediatr Dermatol. May-Jun 2004;21(3):191-6. [Medline].

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Further Reading

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Keywords

congenital aural sinuses, preauricular fistula, congenital preauricular cysts, congenital ear pit, preauricular pits

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Contributor Information and Disclosures

Author

Noah S Scheinfeld, MD, JD, FAAD, Assistant Clinical Professor, Department of Dermatology, Columbia University; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Private Practice
Noah S Scheinfeld, MD, JD, FAAD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Optigenex Consulting fee Independent contractor

Coauthor(s)

Valerie Nozad, DO, Staff Physician, Beth Israel Medical Center, Department of Internal Medicine, University Hospital for the Albert Einstein College of Medicine
Disclosure: Nothing to disclose.

Jeffrey Weinberg, MD, Director, Clinical Research Center, Department of Dermatology, St Luke's; Assistant Clinical Professor, Department of Dermatology, Columbia University College
Jeffrey Weinberg, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Julie C Harper, MD, Assistant Program Director, Assistant Professor, Department of Dermatology, University of Alabama at Birmingham
Julie C Harper, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
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