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Preauricular Ear Sinus Infection





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Published on May 4, 2008

3 Mount Elizabeth, #07-02, Mount Elizabeth Medical Centre, Singapore 228510

To understand more about preauricular ear sinus disease, watch this video:

To read a patient's experience with preauricular sinus:

Dr Kevin Soh explains how a preauricular ear sinus can get infected, and how surgery is performed to resolve the problem.

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If you prefer to read, rather than watch the video, here’s the transcript.

0:25 – Definition of preauricular sinus: a sinus tract or pit in the preauricular area. It arises because of incomplete fusion of the 6 hillocks that arise from the first and second branchial arches. In this diagram of a 6 week embryo, the branchial apparatus forms the structures of the neck.

0:48 – The first branchial arch is supplied by the fifth cranial nerve (trigeminal nerve). The second branchial arch is supplied by the seventh cranial nerve (facial nerve). The first branchial pouch (which lies between the first and second branchial arch) is lined by endoderm. The corresponding first branchial cleft is lined by ectoderm.

1:18 – The first branchial arch gives rise to auricular hillocks 1, 2 and 3. The second branchial arch gives rise to auricular hillocks 4, 5 and 6. The auricle (or pinna) is formed by the combination of these 6 auricular hillocks.

1:43 – Hillock 1 forms the tragus. Hillock 2 forms the crus of the helix. Hillock 3 forms the helix. Hillock 4 forms the anti-helix, superior crus, inferior crus, and the fossa triangularis. Hillock 5 forms the anti-tragus. Hillock 6 forms the lobule.

2:11 – The first branchial cleft forms the external ear canal (external auditory canal). The first branchial pouch forms the Eustachian tube and middle ear space. The malleus and incus develops from the first branchial arch. The stapes develops from the second branchial arch.

2:50 – The preauricular sinus opening and tract is demonstrated. The sinus tract fills up with pus when infected. The sinus tract branches in different directions. The sinus tract may extend very far forwards. Thus, an abscess can form far away from the sinus opening.

3:32 – If I drain the forward located abscess using an incision directly on the abscess, then later create another incision to excise the sinus tract, I will end up with two incisions instead of only one. So what I prefer to do is to create an incision over the sinus tract opening, and create a tunnel towards the abscess.

4:08 – If the abscess is situated directly at the sinus opening, then draining the abscess is a simple decision. The incision is simply made over the abscess, which corresponds with where the sinus opening is located. After the abscess cavity is cleared of pus, a corrugated drain is placed to prevent the wound from closing too soon and prematurely. The corrugated drain prevents the pus from re-accumulating. The corrugated drain will be removed in one to two days time to allow the wound to close spontaneously. After the wound has recovered from abscess drainage, the sinus tract is completely removed to prevent re-infection.

5:02 – Demonstration of Surgical Procedure: Methylene blue dye is injected into the sinus tract to help me see the sinus tract properly. An elliptical skin incision is made. A fine tip radiofrequency probe is used to obtain bloodless dissection. The blue dye in the sinus tract helps me differentiate normal from abnormal tissue. As you can see, quite a large amount of unhealthy tissue is removed. This is inevitable. Inadequate removal will result in recurrence of infection and failed surgery.

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