Preauricular sinus and cyst explained

Preauricular sinus and cyst
Synonyms:	Congenital auricular fistula, Congenital preauricular fistula, Ear pit,^[1] or a Preauricular cyst^[2]

Preauricular sinuses and preauricular cysts are two common congenital malformations. Each involves the external ear. The difference between them is that a cyst does not connect with the skin, but a sinus does. ^[3] Frequency of preauricular sinus differs depending the population: 0.1–0.9% in the US, 0.9% in the UK, and 4–10% in Asia and parts of Africa.^[4]

Preauricular sinuses are inherited features, and frequently appear next to both ears.^[5] Preauricular sinuses can be associated with other defects that are not visible, one example being branchio-oto-renal syndrome.^[6]

Presentation

Complications

Occasionally a preauricular sinus or cyst can become infected.^[7] Most preauricular sinuses are asymptomatic, and remain untreated unless they become infected too often.^[8] Preauricular sinuses can be excised surgically, but often present a high risk of recurrence.^[9]

Causes

Preauricular sinuses and cysts result from developmental defects of the first and second pharyngeal arches.^[10] This and other ear malformations are sometimes associated with renal anomalies.^[11] In rare circumstances these pits may be seen in genetic conditions such as branchio-oto-renal syndrome; however these conditions are always concurrent with other health concerns.^[12]

Treatment

Courses of treatment typically include the following:^[13]

• Surgical excision is indicated with recurrent fistular infections,^[14] preferably after significant healing of the infection. In case of a persistent infection, infection drainage is performed during the excision operation. The operation is generally performed by an appropriately trained specialist surgeon e.g. an otolaryngologist or a specialist General Surgeon.
• The fistula can be excised as a cosmetic operation even though no infection appeared. The procedure is considered an elective operation in the absence of any associated complications.

See also

• Branchial cleft cyst
• Thyroglossal cyst
• Lachiewicz–Sibley syndrome
• List of cutaneous conditions

Bibliography

• Leopardi G, Chiarella G, Conti S, Cassandro E . Surgical treatment of recurring preauricular sinus: supra-auricular approach . Acta Otorhinolaryngologica Italica . 28 . 6 . 302–5 . December 2008 . 19205595 . 2689545 .
• Kim JR, Kim DH, Kong SK, Gu PM, Hong TU, Kim BJ, Heo KW . Congenital periauricular fistulas: possible variants of the preauricular sinus . International Journal of Pediatric Otorhinolaryngology . 78 . 11 . 1843–8 . November 2014 . 25190621 . 10.1016/j.ijporl.2014.08.005 . 1885028 .

Further reading

• Tan T, Constantinides H, Mitchell TE . The preauricular sinus: A review of its aetiology, clinical presentation and management . International Journal of Pediatric Otorhinolaryngology . 69 . 11 . 1469–74 . November 2005 . 16125253 . 10.1016/j.ijporl.2005.07.008 .

Notes and References

1. Book: Irwin M . Freedberg . Thomas B . Fitzpatrick . vanc . 2003 . Fitzpatrick's Dermatology in General Medicine . 6th . McGraw-Hill . 978-0-07-138076-8 .
2. Book: Rapini . Ronald P. . Bolognia . Jean L. . Jorizzo . Joseph L. . vanc . Dermatology: 2-Volume Set . Mosby . St. Louis . 2007 . 978-1-4160-2999-1 .
3. Thatcher, A.L. (2022). Congenital and inflammatory neck masses in children. In M. Lesperance (Ed.), Cummings Pediatric Otolaryngology, 23, 308-321.
4. Kim HJ, Lee JH, Cho HS, Moon IS . A case of bilateral postauricular sinuses . Korean Journal of Audiology . 16 . 2 . 99–101 . September 2012 . 24653881 . 3936561 . 10.7874/kja.2012.16.2.99 .
5. Moore, K.L., Persaud, T.V.N., & Torchia, M.G. (2010). Development of eyes and ears. Before we are born, 17, 257-268.e1.
6. Web site: MedlinePlus Genetics [Internet] . 18 August 2020 . Branchiootorenal/branchiootic syndrome . 16 March 2022 . MedlinePlus.
7. Book: James . William D. . Berger . Timothy G. . vanc . Andrews' Diseases of the Skin: Clinical Dermatology . Saunders Elsevier . 2006 . 978-0-7216-2921-6 . etal.
8. Book: Stephen . Ludwig . Stephan . Strobel . Stephen D. . Marks . Pete K. . Smith . Magdi H. . El Habbal . Lewis . Spitz . vanc . Visual Handbook of Pediatrics and Child Health . Lippincott Williams & Wilkins . 2008 . 517 . 978-0-7817-9505-0 .
9. Leopardi G, Chiarella G, Conti S, Cassandro E . Surgical treatment of recurring preauricular sinus: supra-auricular approach . Acta Otorhinolaryngologica Italica . 28 . 6 . 302–5 . December 2008 . 19205595 . 2689545 .
10. Web site: Preauricular Sinus. 24 Feb 2009. Stedman's Medical Spellchecker . cited in WrongDiagnosis.com. 2006 .
11. Wang RY, Earl DL, Ruder RO, Graham JM . Syndromic ear anomalies and renal ultrasounds . Pediatrics . 108 . 2 . E32 . August 2001 . 11483842 . 10.1542/peds.108.2.e32 . free .
12. Web site: Branchiootorenal syndrome . Genetic and Rare Diseases Information Center (GARD) . 2018-07-05 . 2018-07-05 . https://web.archive.org/web/20180705233028/https://rarediseases.info.nih.gov/diseases/10147/branchiootorenal-syndrome . dead .
13. Web site: Philadelphia . The Children's Hospital of . 2016-07-06 . Preauricular Pits . 2024-04-15 . www.chop.edu . en.
14. Dellinger, M.B., & Waldhausen, J.H.T. (2020). Head and neck sinuses and masses. In Holcomb and Ashcraft's Pediatric Surgery, 72, 1171-1185.