title here

(or press ESC or click the overlay)

poster

Testimonials

  • Everything went well with my treatment, and for that I am very satisfied. Id recommend BHMG for the good service and friendly staff. Ill come back most likely for another treatment.

    Marieta
    Philippines
  • So far this clinic has been replying to every email that I've sent.

    Thelma
    Guam
  • Im pleased with the outcome of my surgery. It went smoothly and the sutures are very smooth. I will definitely recommend Beverly Hills Medical Group, and I would go back again for future treat...

    Maria
    Philippines
  • I was chatting with BHMG online for three months before finally coming to the Philippines to have surgery. I wasnt at all nervous. Instead I was happy and impatient. The clinic in Makati was just as everyone had described it:...

    Edith V., Canada
    Canada
  • Hi.  Im an OFW who saved my money to come home for surgery.  Thank you for the great price and even better service.               

    O. Takashemura
    Japan
  • I'm a medical practitioner in the US and had my surgery done at your facility.  Your staff and service was out of this world and they made my surgery and enjoyable one. 

    cbettty
    United States

Pre-auricular Cyst

What is Excision Pre-auricular Cyst?

Preauricular cysts, pits, fissures, and sinuses are benign congenital malformations of the preauricular soft tissues. Preauricular sinuses or cysts are found lateral and superior to the facial nerve and parotid gland, whereas first branchial cleft malformations are found in close association with these structures, as well as with the external auditory canal.

Simple preauricular cysts should not be confused with first branchial cleft cysts. Branchial cleft anomalies are closely associated with the external auditory canal, tympanic membrane, angle of the mandible, and/or facial nerve. Misinterpreting a first brachial abnormality for a simple sinus tract may place the unsuspecting physician at risk for damaging the facial nerve, incompletely excising the lesion, or both.

Effects of Excision Pre-auricular Cyst

The prognosis is excellent if the tract, fissure, and/or cyst is completely removed.

Candidates for Excision Pre-auricular Cyst

Patients with preauricular sinuses present to the clinician with persistent discharge, recurrent infections or recurrence after surgery.

Malformations of the external ear are not uncommon. These conditions affect males and females equally and have no race predilection.

Your Consultation

Most patients with preauricular pits in the typical location are asymptomatic and require no surgical intervention. Needle aspiration is indicated for abscess that fails to respond to antibiotics. Incision and drainage complicates later excision and should be reserved for abscess that recurs after needle aspiration.

Complete excision of the cyst or sinus tract may be undertaken in cases of recurrent infection.

The Excision Pre-auricular Cyst Ear Procedure

The authors discourage standard incision and drainage in the setting of abscess formation within a preauricular sinus tract or cyst. A potential alternative to incision and drainage is the use of a blunt-ended lacrimal probe inserted into the preauricular pit in order to open the abscess cavity. However, acute inflammation usually makes this option both technically difficult and painful. Aspiration with a 21-gauge needle reliably provides at least temporary relief, eases pain, and provides purulent material for culture and sensitivity. Needle aspiration may need to be repeated if an abscess reaccumulates, but reliably leads to a better cosmetic result than incision and drainage.

Complete surgical excision of a preauricular sinus tract or cyst is indicated in the setting of recurrent or persistent infection. The operation is typically performed when the acute infection has subsided. Recurrence rates following excision range from 0-42%. Factors that reportedly reduce the risk of recurrence include complete excision of the sinus and tract with associated perichondrium, dissection down to temporalis fascia, closure of dead space, and avoidance of sinus rupture.

Inflammation always exists to varying degrees around the cyst wall in the surgical field. Using auricular cartilage as a posterior boundary and the preparotid fascia as a medial boundary helps to assure complete excision when edema and fibrosis obscure the cyst wall. Some authorities recommend methylene blue injection into the cyst to caution against cyst wall violation, but the dye invariably leaks out of the tract into the surgical field, offsetting its benefit. The authors favor the use of a lacrimal probe during the procedure to help define the cyst's periphery.

Recovery

A small rubber band drain may be used and is removed the next day. flexible dressing may be applied over the ear and around the head. The dressing is removed the next day.

Passive drain should be removed on the first postoperative day. Keep the wound dry for 3 days. Watch for bleeding, erythema, and fever. Patients should report any of these unusual symptoms. Purulent drainage is uncommon. Children usually resume normal activities by the following day. A follow-up visit should occur 7-14 days after surgery for wound evaluation.

Risks

Bleeding and infection are the most common complications. Incomplete control of bleeding with failure to close the wound sufficiently may allow bacteria to flourish under the skin, causing infection and wound breakdown.

A seroma may form but typically responds to simple needle drainage or observation. A thick scar may form in wounds closed with too much tension. Scar formation is associated with skin of moderate or high melanin content. Keloid formation is also possible.

Incomplete removal of a sinus tract may lead to recurrence.

FAQs

What is a Pre-auricular sinus/pit?

Preauricular sinuses are common congenital malformations that usually occur at the anterior margin of the ascending limb of the helix.

What happens during the procedure?

Although several techniques for excision have been described, the following is a standard approach:

  • The pit is excised with a rim of normal tissue.
  • A probe may be placed to follow the tract down to the base.
  • Blue dye may be used to document the extent of the tract.
  • A rim of auricular cartilage may be taken near the base of the tract to reduce recurrence.
  • Avoid violating the skin of the auricle.
  • Try to preserve skin that overlies the cyst, even if it looks nonviable.
  • If greater exposure is required, the incision may be extended into the postauricular groove.
  • Bipolar cautery and blunt dissection facilitate tissue plane preservation.
  • The wound is irrigated and closed with absorbable sutures.

What are the indications of preauricular cysts/pits?

Most patients with preauricular pits in the typical location are asymptomatic and require no surgical intervention. Needle aspiration is indicated for abscess that fails to respond to antibiotics. Incision and drainage complicates later excision and should be reserved for abscess that recurs after needle aspiration.

Complete excision of the cyst or sinus tract may be undertaken in cases of recurrent infection.

What are the risks and complications involved in this procedure?

Previously infected cysts and tracts may cause deeper tissue damage that requires rotational and or advancement flap procedures for improved cosmetic outcome. Bleeding and infection are the most common complications. Incomplete control of bleeding with failure to close the wound sufficiently may allow bacteria to flourish under the skin, causing infection and wound breakdown.