A Case of Bilateral Postauricular Sinuses
A 27 year old male visited the department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University hospital, with complaints of painful swelling, erythema, and tenderness on the left retroauricular area. He had a history of incision and drainage twice in the right ear, and once in the left ear due to similar symptoms in the past. On physical examination, there was swelling and tenderness in the left retroauricular area. Further, in the center of the crus of helix, there was a small opening showing pus drainage. There was no swelling or tenderness on the right auricle, but there was a small opening in the center of the crus of helix.\nSince there were sinus openings in both crus of helix (), manifestations of retroauricular area swelling, and history of recurrent infection, the patient was prediagnosed as the bilateral variant type of preauricular sinus, called 'postauricular sinus'. Surgery was performed after one week of antibiotics treatment and acute inflammation was relieved. Fistulography was performed in order to identify the location of the sinus and the length of the sinus tract, and there were a 0.5 cm, 1.0 cm sized sinus tract for each right and left side, heading towards the posterior-middle portion of the auricles ().\nDuring the surgery, local anesthesia was performed around the left sinus opening and retroauricular area. Then, gentian violet was injected into the sinus tract for dyeing. Perpendicular-oval shaped incision, including the opening of the sinus, was done and excision was preceded by identifying the dyed sinus. The direction of the sinus tract could be indentified using a lacrimal probe. The sinus was observed to penetrate the cartilage of the crus of helix and directed toward posterior part of the auricle as in the sinus form. Retroauricular incision was performed for complete removal of the sinus, and cartilage of the crus of helix was also removed (). Then, a drain was inserted and primary closure was performed. Same procedure was performed for the right side, but upon the insertion of the probe, the length of the sinus was small, and it was observed that it invaded to invade only a portion of cartilage of the crus of helix. Therefore, only an incision around the sinus opening was used completely to remove the sinus (). The patient was discharged without complications and total stitch off was done 7 days after the surgery. Histopathologic studies diagnosis was confirmed it as preauricular sinus, since the sinus tract lined with chronic inflammatory squamous epithelium (, ), and 12 months after the surgery, the patient is on follow up without complications and signs of recurrence.