A preauricular sinus is a congenital anomaly and it appears adjacent to the external ear, usually at the anterior margin of the ascending limb of the helix. Anatomically, preauricular sinuses are lateral and superior to the facial nerve and the parotid gland. In almost all cases, the duct connects to the perichondrium of the auricular cartilage. They can extend into the parotid gland.
Preauricular sinuses are inherited in an incomplete autosomal dominant pattern. They can arise spontaneously. The sinus may be bilateral in 25-50% of cases, and bilateral sinuses are more likely to be hereditary. In unilateral cases, the left side is more commonly affected.
Preauricular sinuses are thought to occur as a result of incomplete fusion of the branchial arches.
Surgical excision of Preauricular sinus under microscope guidance and under methylene blue and probe guidance in our series have very low overall recurrence and complication rates compared to that reported in the literature. The microscope group has a statistically lower recurrence rate in comparison to the methylene blue and probe group.
Infection is controlled and a period of 2-3 weeks allowed before surgery is undertaken. General anesthesia was used in all cases. Gentle probing with a blunt ended malleable probe is done first to delineate the extent and presence of multiple ramifications.
Local infiltration of 2% lignocaine and adrenaline around the delineated area is done. An elliptical incision including the sinus opening was used. A zigzag incision was used where multiple openings were present, to give maximum exposure. A portion of the auricular cartilage, which is attached to the tract, is also removed, decreasing the incidence of recurrence to 5%.
Magnification with an operating microscope enables precise dissection without any epithelial breach. Copious local infiltration with adrenaline facilitates a bloodless field for the surgeon, making dissection more easy and fruitful.
Most postoperative recurrences occur because of incomplete removal of the sinus tract.
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