Surgical Management of Preauricular Sinus: A Histopathological Analysis

Background: Consensus on removing a part of the helical cartilage during preauricular sinus surgery is lacking. A thorough understanding of the histopathological characteristics can improve surgical decisions. Methods: We reviewed the histopathological characteristics of preauricular sinuses in 54 patients who underwent surgery between October 2020 and October 2021. Results: The mean distance between the squamous tract and excised auricular cartilage was 0.38 mm. The maximum tract diameter in primary and recurrent cases was 0.52 cm (range, 0.1-2.8 cm) and 0.42 cm (0.1-1.1 cm), respectively. Mild and severe infections were more frequent in the primary group, whereas moderate infections were more frequent in the recurrent groups. Myofibroblast proliferation was more frequent in recurrent cases than in primary cases. However, cysts, granulation tissue, multinucleated giant cells were more frequent in the primary group. Conclusion: We recommend removal of a small portion of the ascending helix cartilage during preauricular sinus surgery to prevent recurrence. Alternatively, the squamous tract should be carefully dissected from the cartilage to ensure complete sinus excision.