Pre-Auricular Sinus: Comparative Study of Two Surgical Techniques

Background/ Purpose: Preauricular sinuses (PAS) are common congenital abnormalities seen in 0.3-0.9% among the pediatric population. Surgical excision is indicated if frequent discharge or recurrent infection and abscesses occur. The aim of this study is to compare the surgical outcome after standard sinectomy versus supra-auricular approach. Materials & Methods: Between January 2000 and December 2004, 63 children underwent surgical excision of symptomatic PAS in Pediatric Surgery Unit, Zagazig University Hospital. These patients were classified into two groups according the used surgical technique: group 1 had standard sinectomy technique, and group 2 had supra-auricular approach. Recurrence was considered if there was recurrence of discharge, abscess formation, local inflammatory signs or preauricular mass after initial healing of the wound. Time of recurrence and need for additional surgery were also documented. The results were statistically analyzed using Student t test and chi square test. Results: There were 30 cases in group 1 versus 33 cases in group 2. The mean age at operation for group 1 and group 2 was 5 +/- 3.1 years and 4.9 +/- 2.9 years respectively. There were 16 males and 14 females in group 1 versus 22 males and 11 females in group 2. Follow up ranged from 2 years to 4 years (mean = 3.1 years). The total recurrence rate was 13 cases (20.6%), Time of recurrence ranged from 4 months to 3 years after surgical excision (median = 7 months). Recurrence occurred in 10 cases of group 1 (33.3%), versus 3 cases in group 2 (9.1%). The recurrence rate between the two groups was statistically significant (P < 0.05). Three cases (4.7%) had abnormal renal ultrasound results, one case in group 1 had unilateral ectopic pelvic kidney, two cases of unilateral hydronephrosis due to vesicoureteric reflux (one in each group). All patients enrolled in this study were isolated cases (not part of a syndrome). Conclusion: supra-auricular approach for excision of PAS in children is associated with statistically significant lower recurrence rate than standard sinectomy technique. There is higher incidence of associated renal anomalies with PAS in non syndromic children than the renal anomalies incidence in general pediatric population. Renal Ultrasound should be done routinely in all cases of PAS.