Outcomes of single-stage excision in infected preauricular sinus: a retrospective cohort study

Preauricular sinus is a common congenital malformation that can become infected. The traditional treatment paradigm has been to settle any infection followed by delayed second-stage excision. This has been thought to achieve better post-operative outcomes and lower risk of recurrence. More recently, however, there have been studies reporting similar outcomes with emergency single-stage 'hot' excision. There are also few microbiological studies; hence, there is need to elucidate the bacteriology in an Australian population.

A 10-year retrospective review of preauricular sinuses treated with surgery by the Otolaryngology department at the Royal Children's Hospital, Melbourne.

Seventy-six sinuses were treated with surgical excision. 70.7% of sinuses had been previously infected. Elective excision occurred in 85.5%, while the remaining 14.5% underwent single-stage excision. 36.8% of sinuses were actively infected at the time of excision even though they may have been elective cases. There were two cases of sinus recurrence in elective cases. There was no significant difference in recurrence rates with regards to previous infections, management of infections, active infection at the time of excision nor elective versus emergency single-stage excision. The most common microorganisms were anaerobes, staphylococcus aureus, and upper respiratory tract flora. Multiple organisms were implicated in 77.6% of cases.

Traditionally, the treatment paradigm of infected preauricular sinuses has been to settle the infection followed by delayed second-stage excision. This study demonstrates that single-stage excision of actively infected sinuses is a safe and viable treatment option. We suggest the addition of anti-anaerobic antimicrobials in the treatment of infection.