Preauricular sinus is a common congenital malformation. Unusual presentations can be subtle with some difficulty in obtaining diagnosis. A 27-year-old woman with 6 months history of recurrent right postauricular swelling which was initially thought to be a recurrent mastoid abscess presented. She had repeated incision and drainage with recurrent post auricular abscess. An incidental extravasation of fluid from an asymptomatic preauricular sinus during postauricular abscess cavity irrigation and a positive fistulogram revealed the diagnosis. Combined excision of the preauricular sinus tract and postauricular abscess cavity achieved a good outcome with patient been asymptomatic over a period of one-year follow-up. There should be a high index of suspicion of recurrent abscesses in close proximity with an ipsilateral preauricular sinus in the head and neck region.
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