Supra-auricular versus Sinusectomy Approaches for Preauricular Sinuses

We performed searches in the LILACS, MEDLINE, SciELO, PubMed databases and Cochrane Library in September, 2015, and the key words used in the search were "preauricular sinus," "sinusectomy," "supra-auricular approach," "methylene blue," and/or "recurrence." We revised the results of 17 studies, including 1270 preauricular sinuses that were surgically excised by sinusectomy in 937 ears and by supra-auricular approach in 333 ears. Recurrence with supra-auricular was 4 (1.3%) while sinusectomy was 76 (8.1%) with significant difference (p< 0.0001). There were no reported facial nerve paresis or paralysis in any of the approaches. The sinusectomy approach showed significantly more complications (p= 0.0048).

Conclusion

Supra-auricular approach had significantly less recurrence rate than tract sinusectomy approaches. Thus, it could be regularly chosen as the standard procedure for preauricular sinus excision. As such, it would be helpful for surgeons to be familiar with this approach.

Keywords:
recurrence; preauricular fistulae; facial nerve

Study	Year	Number of ears/ approach	Recurrence
Study	Year	Sinusectomy or its modifications	Supra auricular
Lam et al ¹²12 Lam HCK, Soo G, Wormald PJ, Van Hasselt CA. Excision of the preauricular sinus: a comparison of two surgical techniques. Laryngoscope 2001;111(2):317-319	2001	25	–	8
		–	27	1
Vijayendra ¹⁶16 Vijayendra H, Sangeetha R, Chetty KR. A safe and reliable technique in the management of preauricular sinus. Indian J Otolaryngol Head Neck Surg 2005;57(4):294-295	2005	–	36	0
Baatenburg de Jong ¹⁴14 Baatenburg de Jong RJ. A new surgical technique for treatment of preauricular sinus. Surgery 2005;137(5):567-570	2005	40	–	2
Yeo et al ⁴4 Yeo SW, Jun BC, Park SN, et al. The preauricular sinus: factors contributing to recurrence after surgery. Am J Otolaryngol 2006; 27(6):396-400	2006	206	–	10
Hassan and Samir ¹⁷17 Mohamed EG. Hassan, Ayman Samir. Pre-Auricular sinus: comparative study of two surgical techniques. Ann Pediatr Surg 2007 ; 3:139-143	2007	30	–	10
		–	33	3
Tang et al ¹⁸18 Tang IP, Shashinder S, Kuljit S, Gopala KG. Outcome of patients presenting with preauricular sinus in a tertiary centre-a five year experience. Med J Malaysia 2007;62(1):53-55	2007	73	–	10
Leopardi et al ¹⁹19 Leopardi G, Chiarella G, Conti S, Cassandro E. Surgical treatment of recurring preauricular sinus: supra-auricular approach. Acta Otorhinolaryngol Ital 2008;28(6):302-305	2008	–	6	0
Bhandary et al ²⁰20 Bhandary S, Singh RK, Karki P, Sharma SK, Chettri ST. Preauricular sinus: Prospective study of clinical course and associations. Gujarat Journal of Otorhinolaryngology and Head & Neck Surgery 2009;6(2):6-9	2009	77	–	2
Bae et al ²¹21 Bae SC, Yun SH, Park KH, et al. Preauricular sinus: advantage of the drainless minimal supra-auricular approach. Am J Otolaryngol 2012;33(4):427-431	2012	–	101	0
Gan et al ¹⁵15 Gan EC, Anicete R, Tan HK, Balakrishnan A. Preauricular sinuses in the pediatric population: techniques and recurrence rates. Int J Pediatr Otorhinolaryngol 2013;77(3):372-378	2013	208	–	5
Huang et al ¹³13 Huang WJ, Chu CH, Wang MC, Kuo CL, Shiao AS. Decision making in the choice of surgical management for preauricular sinuses with different severities. Otolaryngol Head Neck Surg 2013;148(6): 959-964	2013	79	–	8
		–	30	0
Tariq et al ²²22 Tariq M, Murtaza G, Akram A, Bashir T. Pre-Auricular sinus and its microsurgical excision. Esculapio 2013;9(3):123-125	2013	30	–	3
Kavuturu et al ²³23 Kumar Chowdary KV, Sateesh Chandra N, Karthik Madesh R. Preauricular sinus: a novel approach. Indian J Otolaryngol Head Neck Surg 2013;65(3):234-236	2013	–	34	0
Mundra et al ²⁴24 Mundra RK, Sinha R, Agrawal R. Supra-auricular approach: a simple recurrence-free technique for pre-auricular sinus. EJNSO 2014;1(1):11-15	2014	–	15	0
Bhandari et al ²⁵25 Bhandari R, Limbu TR, Parajuli R, Thapa S. Auricular dissection method for treatment of preauricular sinus. Journal of Chitwan Medical College 2014;4(9):21-24	2014	–	51	0
Goel et al ²⁶26 Goel AK, Sylonia SC, Garg A, Rattan K. Preauricular sinus: When to operate? Indian Journal of Otology 2011;17(2):63-65	2015	112	–	18
Yoo et al ²⁷27 Yoo H, Park DH, Lee J, Park MC. A Surgical Technique for congenital preauricular sinus. Arch Craniofac Surg 2015;16(2):63-66	2015	57	–	0

Approach	Number of ears	Recurrence	Chi square test	p value
Supra auricular	333	4 (1.2%)	19.874	< 0.0001 HS
Sinusectomy or its modifications	937	76 (8.1%)	19.874	< 0.0001 HS

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[1] Conflict of Interest and Financial Disclosure Statement

The authors declare no financial support or conflict of interest in this study.