대한두개안면성형외과학회지 (Archives of Craniofacial Surgery)

  • 제24권5호
  • /
  • Pages.223-229
  • /
  • 2023
  • /
  • 2287-1152(pISSN)
  • /
  • 2287-5603(eISSN)
대한두개안면성형외과학회 (Korean Cleft Palate-Craniofacial Association)
권호 표지
DOI QR코드

DOI QR Code

Standardized surgical strategy for the treatment of preauricular sinus to reduce recurrence

  • Hannara Park (Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital) ;
  • Jaemin Seong (Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital) ;
  • Hyouchun Park (Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital) ;
  • Hyeonjung Yeo (Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital)
  • 투고 : 2023.09.03
  • 심사 : 2023.10.09
  • 발행 : 2023.10.20
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: Preauricular sinus (PAS) is a common congenital anomaly, and complete excision is recommended to prevent recurrence. However, PAS has a high recurrence rate as a result of incomplete removal due to the high variability of the sinus ramifications, making its treatment challenging. In this study, we standardized the surgical procedure to reduce the complications and recurrence rate and compared the postoperative results between the non-standardized and the standardized groups. Methods: This retrospective study included 97 patients (120 ears) who had undergone PAS excision by a single surgeon between October 2014 and September 2022 and underwent at least 6 months of follow-up. After October 2018, all patients were treated using the standardized method, which comprised the use of magnifying glasses, exploration with a lacrimal probe, the use of methylene blue staining, and excision of a piece of surrounding normal tissue and related cartilage in continuity with the specimen. There were 38 patients (45 ears) in the non-standardized group and 59 patients (75 ears) in the standardized group. Results: Recurrence was observed in six of 120 ears, indicating an overall recurrence rate of 5.0%. Recurrence occurred in five ears (11.1%) in the non-standardized group and one ear (1.3%) in the standardized group. The standardized group had a significantly lower recurrence rate (p= 0.027) than the non-standardized group. Conclusion: We defined a standardized sinectomy protocol and used it for the surgical treatment of PAS. With this standardized method, we were able to reduce the rates of complications and recurrence without the use of a long incision.

키워드

참고문헌

  1. Heusinger. Hals-Kiemen-Fisteln von noch nicht beobachteter Form. Archiv f pathol Anat 1864;29:358-80.  https://doi.org/10.1007/BF01937182
  2. Zou F, Peng Y, Wang X, Sun A, Liu W, Bai S, et al. A locus for congenital preauricular fistula maps to chromosome 8q11.1-q13.3. J Hum Genet 2003;48:155-8.  https://doi.org/10.1007/s100380300024
  3. An SY, Choi HG, Lee JS, Kim JH, Yoo SW, Park B. Analysis of incidence and genetic predisposition of preauricular sinus. Int J Pediatr Otorhinolaryngol 2014;78:2255-7.  https://doi.org/10.1016/j.ijporl.2014.10.027
  4. Scheinfeld NS, Silverberg NB, Weinberg JM, Nozad V. The preauricular sinus: a review of its clinical presentation, treatment, and associations. Pediatr Dermatol 2004;21:191-6.  https://doi.org/10.1111/j.0736-8046.2004.21301.x
  5. Lee KY, Woo SY, Kim SW, Yang JE, Cho YS. The prevalence of preauricular sinus and associated factors in a nationwide population-based survey of South Korea. Otol Neurotol 2014;35:1835-8.  https://doi.org/10.1097/MAO.0000000000000587
  6. Yeo SW, Jun BC, Park SN, Lee JH, Song CE, Chang KH, et al. The preauricular sinus: factors contributing to recurrence after surgery. Am J Otolaryngol 2006;27:396-400.  https://doi.org/10.1016/j.amjoto.2006.03.008
  7. Huang XY, Tay GS, Wansaicheong GK, Low WK. Preauricular sinus: clinical course and associations. Arch Otolaryngol Head Neck Surg 2007;133:65-8.  https://doi.org/10.1001/archotol.133.1.65
  8. Huang WJ, Chu CH, Wang MC, Kuo CL, Shiao AS. Decision making in the choice of surgical management for preauricular sinuses with different severities. Otolaryngol Head Neck Surg 2013;148:959-64.  https://doi.org/10.1177/0194599813483447
  9. Bruijnzeel H, van den Aardweg MT, Grolman W, Stegeman I, van der Veen EL. A systematic review on the surgical outcome of preauricular sinus excision techniques. Laryngoscope 2016;126:1535-44.  https://doi.org/10.1002/lary.25829
  10. Chan KC, Kuo HT, Wai-Yee Ho V, Chuang WY, Chen ZC. A modified supra-auricular approach with helix cartilage suture for surgical treatment of the preauricular sinus. Int J Pediatr Otorhinolaryngol 2018;114:147-52.  https://doi.org/10.1016/j.ijporl.2018.08.041
  11. Bae SC, Yun SH, Park KH, Chang KH, Lee DH, Jeon EJ, et al. Preauricular sinus: advantage of the drainless minimal supra-auricular approach. Am J Otolaryngol 2012;33:427-31.  https://doi.org/10.1016/j.amjoto.2011.10.015
  12. Leopardi G, Chiarella G, Conti S, Cassandro E. Surgical treatment of recurring preauricular sinus: supra-auricular approach. Acta Otorhinolaryngol Ital 2008;28:302-5. 
  13. Lam HC, Soo G, Wormald PJ, Van Hasselt CA. Excision of the preauricular sinus: a comparison of two surgical techniques. Laryngoscope 2001;111:317-9.  https://doi.org/10.1097/00005537-200102000-00024
  14. Kim WJ, Lee YM, Kim DH, Choe S, Lee D, Park SY, et al. Causes and prevention of revision surgery for preauricular sinus: a histopathological analysis. Int J Pediatr Otorhinolaryngol 2019;116:199-203.  https://doi.org/10.1016/j.ijporl.2018.11.006
  15. Prasad S, Grundfast K, Milmoe G. Management of congenital preauricular pit and sinus tract in children. Laryngoscope 1990;100:320-1.  https://doi.org/10.1288/00005537-199003000-00021
  16. Han JS, Park JM, Han JJ, Cho YS, Vidal JL, Park SY, et al. Surgical results of infected preauricular sinus: no need for delay. Int J Pediatr Otorhinolaryngol 2020;135:110129. 
  17. El-Anwar MW, ElAassar AS. Supra-auricular versus sinusectomy approaches for preauricular sinuses. Int Arch Otorhinolaryngol 2016;20:390-3.  https://doi.org/10.1055/s-0036-1583305
  18. Gur E, Yeung A, Al-Azzawi M, Thomson H. The excised preauricular sinus in 14 years of experience: is there a problem? Plast Reconstr Surg 1998;102:1405-8.  https://doi.org/10.1097/00006534-199810000-00012
  19. Tang IP, Shashinder S, Kuljit S, Gopala KG. Outcome of patients presenting with preauricular sinus in a tertiary centre: a five year experience. Med J Malaysia 2007;62:53-5. 
  20. Kim MS, Choi SW, Lee SH, Lee JW, Lee IW, Lee HM. Surgical treatment of preauricular sinus in children: temporalis muscle fascia anchoring suture. Int J Pediatr Otorhinolaryngol 2020;138:110340. 
  21. Peeters KC, van de Velde CJ. Surgical quality assurance in breast, gastric and rectal cancer. J Surg Oncol 2003;84:107-12.  https://doi.org/10.1002/jso.10312
  22. McCulloch P, Taylor I, Sasako M, Lovett B, Griffin D. Randomised trials in surgery: problems and possible solutions. BMJ 2002;324:1448-51.  https://doi.org/10.1136/bmj.324.7351.1448
  23. Kim DG, Cho HG, Ryu JY, Lee JS, Lee SJ, Lee JM, et al. Clinical assessment and management of auricular arteriovenous malformation: retrospective study. Arch Craniofac Surg 2021;22:141-7.  https://doi.org/10.7181/acfs.2021.00192
  24. Kim JH, Yang YB, Oh DY. Correction of pixie ear: infraauricular skin redraping method. Arch Craniofac Surg 2022;23:187-9. https://doi.org/10.7181/acfs.2022.00675