A preauricular sinus is a tiny pit just in front of the ear, present from birth, leading to a branching tract under the skin. Many never cause trouble and are left alone. Those that repeatedly become infected are removed, and removing them completely is the whole challenge.
Preauricular sinus excision removes the pit in front of the ear together with the entire branching tract beneath it. It is done when the sinus has become infected more than once, because recurrent infection scars the tissue and makes later surgery harder. Complete removal of every branch is what prevents recurrence, so the dissection is wider than the small opening suggests.
The outer ear forms from several small hillocks of tissue that fuse in early development. Where that fusion is incomplete, a narrow tract is left behind, opening as a pit just in front of the upper ear.
The pit itself is unremarkable. What sits beneath it is not. The tract is usually not a simple tube: it branches, it can run deep towards the ear cartilage, and it is lined with skin that sheds and can become infected. Once infection occurs it tends to recur, and each episode leaves scarring that makes the tract harder to follow at operation.
That is why the operation is bigger than the pit suggests. Removing the visible pit and the first centimetre of tract is precisely how recurrence happens: a branch is left behind, it fills again, and the problem returns in scarred tissue that is now more difficult to clear. Complete excision means following every branch to its end, often taking a cuff of tissue around the tract and sometimes a small piece of ear cartilage where the tract reaches it.
An asymptomatic sinus that has never been infected can reasonably be left alone. It is the pattern of infection, not the presence of the pit, that decides.
Timing matters: operating during active infection makes complete removal much harder and recurrence much more likely.
Any active infection is treated and allowed to settle fully. Operating through inflamed tissue is the commonest cause of recurrence.
The tract may be marked with dye or a fine probe at the start so that every branch can be followed.
The pit is encircled with a small ellipse of skin so it is removed in continuity with the tract rather than opened.
The tract is dissected out with a cuff of surrounding tissue, up to and including a small piece of ear cartilage where it reaches it.
The wound is closed in layers with absorbable sutures, placed to sit naturally in front of the ear.
Mild discomfort managed with simple painkillers. A dressing for the first day or two. Some swelling is normal.
Back to school or work. Wound checked. Stitches are absorbable and need no removal.
Scar redness peaks and starts to fade. Normal activity including swimming once fully healed.
Scar matures and pales. Recurrence, if it happens, usually declares itself within the first year.
Complete excision is usually curative and recurrence after a properly performed wide excision is uncommon. Recurrence rates rise sharply after surgery done during active infection, or where only the visible pit was removed. The scar sits in front of the ear and typically fades well, though it is longer than the pit would suggest, and parents are often surprised by that. Where the tract reached the cartilage, a small contour irregularity may be felt.
The facial nerve runs in this region, which is the risk that shapes the dissection.
Straightforward, with one thing worth watching for in the first week.
The pit is the entrance to a branching tract that can run deep towards the ear cartilage. Removing only what is visible is the commonest reason it comes back.
The opposite. Inflamed tissue obscures the tract, makes complete removal much harder and raises the recurrence rate. Infection is settled first.
Many never become infected and can be left alone. It is the pattern of infection that decides, not the presence of the pit.
Recurrence in this operation is almost always a technical matter: a branch left behind, or surgery attempted while the tissue was inflamed. Waiting for infection to settle and then excising widely is unglamorous and is what prevents a second operation.
Excision for recurrent infection is commonly covered by health insurance and by government schemes. Removal of an asymptomatic sinus for appearance may not be. A written estimate follows assessment.
The questions that follow a second course of antibiotics.
Ask your question →No. Many never cause any trouble and can be left alone and watched. Surgery is for those that have become infected more than once, or that discharge persistently.
Because the tract beneath branches and runs deeper than the opening suggests, and every branch has to be followed and removed. A short incision that leaves a branch behind is how recurrence happens.
It is best not to. Inflamed tissue makes the tract very hard to identify, and surgery during infection has a much higher recurrence rate. Infection is treated first and surgery arranged once things are quiet.
Uncommonly, after a complete wide excision in quiet tissue. Recurrence is much more likely after limited surgery or surgery during infection. If it does recur, it usually shows within the first year.
It can run in families and is sometimes bilateral. Where there are other features, particularly hearing or kidney abnormalities, further assessment may be suggested.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
