eMedicine Specialties > Dermatology > Pediatric Diseases

Preauricular Sinuses: Follow-up

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

Follow-up

Further Inpatient Care

  • If the sinus reoccurs, it should be fully removed.

Further Outpatient Care

  • If a preauricular sinus is repeatedly infected and the patient does not want surgery, its contents can be cultured and proper antibiotics to cover the pathogens can be given.

Inpatient & Outpatient Medications

  • Usually, no medications must be given, but if infection occurs, antibiotics can be given. The contents of the sinus should be cultured before antibiotics are prescribed.

Deterrence/Prevention

  • If the sinus becomes repeatedly infected, it can be surgically removed.

Complications

  • Patients may develop infection of the tract with abscess formation.
  • Infections and ulcerations may occur at a site distant from the opening.
  • Postoperative recurrence is a complication of preauricular sinus tract extirpation. Several factors contribute to recurrence after surgery, as follows:
    • Previous attempt at surgical removal
    • Surgery under local anesthesia
    • Incomplete removal of the sinus tract
    • Active infection at the time of surgery
    • Drainage of an abscess prior to surgery
    • Poor delineation of the entire sinus tract during surgery
    • Failing to remove the auricular cartilage at the base of the sinus
    • Failing to identify the facial nerve because it lies close to the sinus
  • Most recurrences occur during the early postoperative period, within 1 month of the procedure. Recurrences should be suspected when discharge from the sinus tract opening persists. The overall incidence of recurrence varies among different studies and ranges from 5-42%.

Prognosis

  • Preauricular sinuses generally have a good prognosis.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize that a preauricular sinus can cause facial abscess and ulceration
  • Failure to recognize that a preauricular sinus can recur after surgery
  • Failure to recognize that a preauricular sinus can be associated with congenital deafness
  • Failure to recognize that a preauricular sinus can result in facial palsy by impinging on facial nerves
  • Failure to recognize that a preauricular sinus can lead to infection if facial surgery is performed proximal to it
  • Failure to consider audiologic or renal evaluation if a preauricular sinus is present
  • Failure to identify an infected preauricular sinus and not treating it with proper antibiotics and/or surgery (A preauricular sinus may be confused with a cyst when infected.)
 


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

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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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