Pre Auricular Sinus : A Clinical Analysis of 62 Cases and Review of Its Micro Surgical Management

Abstract

INTRODUCTION: Pre auricular sinus (PAS) is a common clinical finding seen in the ENT outpatient department. The patients complain only when it is infected, when cheesy material is extruded often form the aural pit. Initial control of infection, incision and drainage of the abscess becomes the primary step in its treatment. This is followed by the attempt to excise the tract to avoid recurrence of cellulitis and abscess. Simple sinectomy leads to recurrence; hence requires microscopic dissection and excision. The present study attempts to analyze the genetic penetration, incidence in various socio-economic groups and at the same time to review the micro surgical management. MATERIALS AND METHODS: 62 patients diagnosed with Preauricular sinus attending department of ENT, GGH; Kurnool were analyzed for genetic role in its etiology in addition to the prevalence of the condition according to the social and economic status. Thorough clinical examination and where necessary audiological evaluation to rule out innner ear pathology was done. Bacteriological study was done subjecting the pus and material extruded from the sinus pits. After a surgical profile all the patients except 4 were subjected to Total excision of the sinus tract using circular incision around the sinus pit and extending it posteriorly around the root of the pinna. All were followed for a period of 12 months to evaluate recurrence rate, Infection rate and wound dehiscence. OBSERVATIONS: Among the 62 patients there were 37 females and 25 males. The patient's age range was from 9 months to 36 years. 18 patients had undergone surgery at least once before presenting in this study. The commonest organism isolated was Staph aureus followed by bacillus fragilis and pseudomonas aeroginosa. Incomplete gene penetration was noted in 34 out of the 62 patients, as PAS was noticed in parents, siblings and grandparents. Follow up showed no recurrence over 1 year. CONCLUSIONS: PAS is a congenital condition within complete genetic penetration; not commonly associated with inner ear or kidney disease. Recurrence is common if only sinectomy is attempted; instead total excision with medial to lateral dissection and post aural extension of incision would give an almost fool proof method to get rid of the sinus once for all.