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[Surgical management and recurrence of congenital preauricular fistula]
M E Chávez Delgado1, S Castro Castañeda, G C Ramírez Jaime
1Servicio de Otorrinolaringología. Hospital General de Zona No. 89, Instituto Mexicano del Seguro Social (IMSS), Tijuana BC. estela_hu@yahoo.com
Insights
The supra-auricular approach significantly reduces preauricular fistula (PAF) recurrence compared to standard techniques. Avoiding cartilage excision at the tract base increases recurrence rates, highlighting the importance of surgical technique in managing PAF.
Area of Science:
- Otolaryngology
- Surgical Innovation
- Medical Research
Context:
- Preauricular fistula (PAF) management presents challenges due to high postoperative recurrence rates.
- Surgical outcomes for PAF are influenced by technique and adherence to specific surgical principles.
- A retrospective study was conducted in Guadalajara, Jalisco, analyzing data from 2001-2006.
Purpose:
- To evaluate and compare the recurrence rates of different surgical techniques for preauricular fistula (PAF).
- To identify surgical factors contributing to the high recurrence rates associated with PAF treatment.
- To provide evidence-based recommendations for optimizing PAF surgical management.
Summary:
- This study reviewed 44 surgical procedures for preauricular fistula (PAF) in 38 patients, analyzing clinical and operative data.
- The supra-auricular approach demonstrated a significantly lower recurrence rate (6.8%) compared to the standard sinectomy technique (52.2%).
- Excision of cartilage at the tract base was crucial, with recurrence rates of 15.3% versus 84.6% when cartilage was not excised.
Impact:
- The findings advocate for the supra-auricular approach, especially in cases with pre-operative abscesses, to minimize PAF recurrence.
- Surgical technique, specifically the supra-auricular method and cartilage excision, is a critical determinant of successful PAF treatment.
- This research offers valuable insights for otolaryngologists and surgeons aiming to improve patient outcomes for preauricular fistula.
Abstract:
In this paper we describe the surgical management and postoperative recurrence of preauricular fistula (PAF) since the surgical treatment is characterized by high recurrence rates. All clinical, operative and postoperative data were collected from a retrospective review of patients's charts who underwent primary surgical management between January 2001 and December 2006 at five Hospitals in Guadalajara, Jalisco. Thirty-eight patients (15 male, 23 female) with PAF underwent 44 surgical procedures. Recurrent acute infection and discharge were the most common symptoms. The surgical management included 25 standard techniques (sinectomy) and 19 supra-auricular approaches. The overall rate of recurrence was 59%, it differed widely between surgical techniques employed. The 52.2% recurrence rate of standard technique was significantly higher than the 6.8% recurrence rate of the supra-auricular approach (p = 0.01). Also, the patients in whom a portion of the cartilage of the helix was not excised from the base of the tract, 84.6% recurred vs. 15.3% when cartilage was excised (p = 0.01). Our experience has shown that independently of clinical presentation of PAF, the standard technique and not to remove a portion of the cartilage at the base of the helix contributed to recurrence. We advise the supra-auricular approach particularly when there are abscess prior to surgery.
