Preauricular sinus is a common condition. A hole near the ear since birth is present in as many as 1% of all individuals. The hole is usually near the upper part of the ear and in front of it. The hole can be only on one side or in front of both ears.
Why does a preauricular sinus occur?
When the face is developing, there are many skin folds. In the vast majority of fetuses, the skin folds fuse seamlessly. In some, the skin folds fuse just that wee bit imperfectly leading to these holes.
Is it just a hole or does it connect to something deeper?
Well, neither. It is a small hole that typically leads to a tunnel-like tract that ends blindly. It is usually adherent to the cartilage of the ear but does not connect to any significant deeper structures. The tunnel has a lining that secretes a minimal quantity of natural oily liquid, just like the skin does, and this liquid is expelled out through the hole.
It is very small. I am sure it can’t cause any harm. It is OK to leave a preauricular sinus as it is, right?
- This is the fate of most preauricular sinuses.
- Normal secretions can clog either the tract or the opening especially because it is very small.
- There is a buildup of secretions behind the opening and a cyst forms.
- If the contents become infected secondarily, the skin over the swelling gets inflamed and the child may even develop a fever. Now a proper abscess has formed.
So what should be done when we see a hole near the ear that is present since birth?
I recommend that the child get a simple surgery to remove the opening and the underlying tract in its entirety. While the opening and the tract look small, it can be tricky to excise the tract completely. A preauricular sinus tract is usually straight, but it can have side-tracts that if left behind, can cause a recurrence of the problem. When we operate a fresh case of preauricular sinus, the chances of recurrence are <5% but when we operate on a child who has already had abscess formation the chances of recurrence can be as high 25%.
Once an abscess develops, we may need to drain the pus as the first step. The infection may get better with just antibiotics, but many require a surgical operation to drain the pus.
All these complications are unnecessary, and it is better to get the preauricular sinus excised whenever convenient, and when the child is healthy.
Surgery will involve anesthesia, right? Doctor, we are scared!
Modern surgery and anesthesia are very safe. You should get your child operated in a good set up at a good hospital with your choice of a pediatric surgeon. Each pediatric surgeon works with excellent pediatric anesthetists. Prepare well for the surgery and you can expect the usual, great outcome.