Early one-stage surgical treatment of infected preauricular sinus.

The objective of this study was to review outcomes of early one-stage surgery of acutely infected preauricular sinus compared to conventional delayed surgery after infection control. The study is a case series with chart review conducted in an academic center. From January 1, 2007 to January 31, 2012, we performed surgical treatments for 136 congenital preauricular sinuses on 103 patients aged 0-15 years. We classified the sinuses according to the state of their infection at the time of the surgery intraoperatively--Group I (asymptomatic; n = 68, 50 %), Group II (infected state; n = 26, 19 %) and Group III (infected state with abscess formation; n = 42, 31 %). The surgical outcomes of Groups I, II, and III were documented during an outpatient department observation period. The follow-up period was from 6 months to over 2 years. One patient from Group II and one patient from Group III had a recurrent infection which could be managed by local infection control. One patient from Group I and one patient from Group III had skin defects by necrosis of a skin flap margin which could be secondarily healed. All patients had no recurrence or significant chronic complications. We performed early one-stage surgical treatments on a total of 136 sinuses with an even acute infection with abscess formation and achieved good surgical outcomes, and patients were satisfied in aspects of treatment period and cost. So we present our early one-stage surgical treatment as a good option for infected preauricular sinus management.

Decision making in the choice of surgical management for preauricular sinuses with different severities.

OBJECTIVES: The preauricular sinus is a common congenital abnormality of the preauricular soft tissues. Here, we demonstrate the decision making in the choice of surgical management of preauricular sinuses based on disease severity. In addition, a method termed figure 8 incision with extended fistulectomy is introduced. STUDY DESIGN: Case series with chart review. SETTING: Tertiary care center. SUBJECTS: Between January 2003 and February 2010, a total of 90 patients (109 ears) underwent surgery for preauricular sinuses in our hospital. METHODS: After controlling the infection, the patients received definite surgery. They were classified into 3 groups according to the operative methods. We recorded the clinical conditions and any recurrences during the follow-up period. RESULTS: Group I patients (48 ears) had a trace inflammatory condition and underwent a simple sinusectomy. The recurrence rate was 2.08%. Group II (31 ears) and group III (30 ears) patients had more highly inflamed tissue and underwent a local wide excision and a figure 8 incision with extended fistulectomy, respectively. The recurrence rate in group II was 22.58%. Meanwhile, none of the group III cases showed a recurrence. In our study, there were 8 recurrent cases in 109 ears, yielding a recurrence rate of 7.34%. CONCLUSION: Simple sinusectomy is an adequate surgical technique for preauricular sinuses with a mild inflammatory condition. For more severe cases, the figure 8 incision with extended fistulectomy can achieve adequate wound exposure for radical excision of the inflamed tissue and a satisfactory surgical outcome.

Intranasal procedures for successful lacrimal surgery.

Successful lacrimal surgery requires specialized knowledge of intranasal surgical anatomy. The clearance of the lower nasolacrimal duct relative to the inferior turbinate and the relationship of dacryocystorhinostomy and conjunctivodac-ryocystorhinostomy sites to upper nasal septum and anterior middle turbinate are not encountered in traditional cosmetic rhinoplasty or procedures for nasal airway obstruction. Intranasal procedures to facilitate lacrimal surgery are described.