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      Summary of the Experience in the Diagnosis and Treatment of Complex Preauricular Fistulas in 78 Children

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          Abstract

          Objective: This study aimed to investigate the application of mini-incisions in complex preauricular fistula resection in children.

          Methods: A total of 78 children who were diagnosed with preauricular fistula infection between January 2017 and December 2019 were included in the study. Their clinical data were analyzed retrospectively, and surgical treatment with mini-incisions based on plastic surgery principles and techniques was provided.

          Results: All the patients achieved healing following the first application of the treatment. The patients were followed up for 6–42 months, and no recurrence or local auricular deformation occurred.

          Conclusion: The application of mini-incisions and plastic surgery techniques in complex preauricular fistula resection in children can achieve a good effect and improve the satisfaction of the children and their parents.

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          Most cited references 19

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          The preauricular sinus: A review of its aetiology, clinical presentation and management.

          The preauricular sinus is a not uncommon finding in the paediatric population. Recent reports have added to our knowledge of this benign malformation. We review the current literature with respect to the aetiology of the condition, its clinical features, and associations with other congenital malformations. In those patients in whom a preauricular sinus is identified, we recommend associated congenital anomalies be sought. In selected cases, a renal ultrasound scan may be appropriate. Where no associated abnormalities are identified, and where the preauricular sinus is asymptomatic, there is consensus opinion that no further action is indicated. In the acute phase of infection, treatment comprises administration of appropriate antibiotics, and incision and drainage of an abscess if present. In the symptomatic preauricular sinus exhibiting recurrent or persistent infection, opinion regarding optimal management varies. Latest evidence suggests definitive surgical treatment offering the most favourable outcome is by wide local excision of the sinus, as opposed to the previously preferred technique of simple sinectomy. Magnification employed during surgery, and opening, and following from the inside as well as outside, branching tracts of the sinus may further minimise the risk of recurrence.
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            The preauricular sinus: a review of its clinical presentation, treatment, and associations.

            Preauricular sinuses (ear pits) are common congenital abnormalities. Usually asymptomatic, they manifest as small dells adjacent to the external ear near the anterior margin of the ascending limb of the helix, most frequently on the right side. Preauricular sinuses can be either inherited or sporadic. When inherited, they show an incomplete autosomal dominant pattern with reduced penetrance and variable expression. They may be bilateral, increasing the likelihood of being inherited, in 25-50% of cases. Preauricular sinuses are features of other conditions or syndromes in 3-10% of cases, primarily in association with deafness and branchio-oto-renal (BOR) syndrome. When other congenital anomalies coexist with these sinuses, auditory testing and renal ultrasound should be considered. Sinuses may become infected, most commonly with gram-positive bacteria, in which case their exudates should be cultured and appropriate antibiotics administered. Recurrent infection is a clear indication for complete excision and provides the only definitive cure. Recurrence rates after surgery range from 9% to 42%. Meticulous excision by an experienced head and neck surgeon minimizes the risk of recurrence.
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              The excised preauricular sinus in 14 years of experience: is there a problem?

              The congenital preauricular sinus is usually asymptomatic. However, if recurrent infection occurs, complete surgical excision of the sinus is required. If the sinus tracts are not entirely removed, recurrence is likely to follow. A retrospective study of the surgical results at The Hospital for Sick Children in Toronto, Ontario, was completed. One-hundred sixty-five primary preauricular excision procedures, performed in 146 patients between the years 1982 and 1996, were reviewed. All clinical, operative, and postoperative data were gathered. Patient outcome and epidemiologic issues were addressed. The overall recurrence rate of this series was 9.09 percent (15 of 165 sinuses). For the group of patients with active infection present at surgery, the recurrence rate was 15.79 percent, and when no infection was present, recurrence rate was 8.22 percent (p value = 0.32, odds ratio = 2.09). Moreover, in patients who underwent surgical drainage of an abscess before the procedure, 16.7 percent of the sinuses recurred, whereas in the patients who did not have an abscess, only 8.16 percent recurred (p value = 0.25, odds ratio = 2.25). In the group of patients in whom auricular cartilage was not excised from the base of the tract, 18.52 percent of the sinuses recurred; when cartilage was excised, the recurrence rate was 4.5 percent (p value = 0.006). A very high recurrence rate of 21.95 percent was found in the group of patients in whom no modality was used to demonstrate the sinus tract at surgery. A high recurrence rate of 10.87 percent was found in the group for whom probing with a cannula was used to identify the tract (p value = 0.17); a low recurrence rate of 2 percent was found in a group with dye injection only (p value = 0.015). In those patients in whom sinus probing and dye injection were used simultaneously, there were no recurrences (0 percent, p value < 0.05). In conclusion, a patient with an actively infected preauricular sinus or one with a previous abscess may have a tendency to experience a higher recurrence rate after excisional surgery. Excising a cartilage piece at the base of the tract and demonstrating the sinus with dye injection or with dye injection and probing at the time of surgery will reduce recurrence rates. In conclusion, we advise the excision of cartilage in the base of the tract as well as the use of methylene blue injection and probing of the sinus at surgery.
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                Author and article information

                Contributors
                Journal
                Front Surg
                Front Surg
                Front. Surg.
                Frontiers in Surgery
                Frontiers Media S.A.
                2296-875X
                01 February 2021
                2020
                : 7
                Affiliations
                1Department of Otorhinolaryngology Head and Neck Surgery Henan Children's Hospital, Department of Otorhinolaryngology Head and Neck Surgery, Zhengzhou Children's Hospital , Zhengzhou, China
                2Department of Otolaryngology Head and Neck Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University Beijing , Beijing, China
                Author notes

                Edited by: Claudine Gysin, University of Zurich, Switzerland

                Reviewed by: Katharina Stölzel, Charité – Universitätsmedizin Berlin, Germany; Jose Angelito Ugalde Hardillo, Erasmus Medical Center, Netherlands

                *Correspondence: Fugen Han hamfugem@ 123456163.com

                This article was submitted to Otorhinolaryngology - Head and Neck Surgery, a section of the journal Frontiers in Surgery

                Article
                10.3389/fsurg.2020.609852
                7882734
                Copyright © 2021 Xu, Seng, Jiang, Wang, Ni, Zhang and Han.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                Page count
                Figures: 2, Tables: 0, Equations: 0, References: 19, Pages: 5, Words: 3546
                Categories
                Surgery
                Original Research

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