Periauricular Cysts and Sinuses

Abstract

Periauricular cysts, sinuses, and fistulas occur commonly in the pediatric population. They arise from developmental defects of the first branchial cleft and first branchial arch. In most instances the diagnosis and management of these conditions are straightforward, but exceptional presentations sometimes occur. Failure to recognize these unusual cases may result in inadequate treatment and subsequent recurrence, and even if the correct diagnosis is made, surgical management of these lesions may be complicated. A series of 15 cases of periauricular congenital lesions is reviewed, of which three cases illustrating a diagnostic or surgical challenge are presented. The embryology, presentation, and management of these anomalies are discussed. This is one of the largest series of first branchial cleft anomalies reported in the literature, and our paper uniquely discusses first branchial cleft anomalies and preauricular sinuses together, with an emphasis on the surgical management of facial nerve, external ear, and middle ear involvement.

Malformations of the first branchial cleft: duplication of the external auditory canal

“…In our case, series there were only two children with type II anomaly. Most cases in the literature are described type II anomalies, and only a few cases are type I [1,2]. Rare congenital external auditory canal atresia, microtia, and cholesteatoma of mastoid and middle ear, in addition to the first branchial cleft anomalies were described by Yalcin et al [11].…”

“…Laboratory studies should be planned to rule out neoplasms and infectious diseases [2]. Computed tomography or magnetic resonance imaging may help identify the extent of the lesion [1,2]. If there is extension into the external canal, tympanic membrane, or middle ear, computed tomography is performed to define the extent of bone involvement [1].…”

“…It is the result of development anomaly of the first branchial cleft. These anomalies are rare; they compromise 1-8% of all branchial anomalies [1]. Clinically, they present as a periauricular cysts, sinus or fistula, rarely as an isolated swelling in the external auditory canal [2].…”

The preauricular sinus: A review of its aetiology, clinical presentation and management

“…The formation of a preauricular sinus occurs during embryogenesis and is closely associated with the development of the auricle during the sixth week of gestation [7]. The auricle develops from six mesenchymal proliferations, known as the hillocks of His; three from the caudal border of the first branchial arch and three from the cephalic border of the second branchial arch [8].…”

Eya1 expression in the developing ear and kidney: Towards the understanding of the pathogenesis of branchio-oto-renal (BOR) syndrome

“…From week 5 in human and E11.5 in the mouse, the sides of the cleft begin to form six mesenchymal hillocks, due to mesenchymal cell proliferation, which eventually fuse to form the auricle. The preauricular pits, cartilaginous appendages, and auricular malformations are considered to arise from incorrect proliferation and disordered fusion of the hillocks (Martins, 1961;Nofsinger et al, 1997). The external auditory canal is formed by proliferation and subsequent canalisation of the meatal plug formed at the dorsal portion of the first branchial cleft.…”