The objective of this study was to review outcomes of early one-stage surgery of acutely infected preauricular sinus compared to conventional delayed surgery after infection control. The study is a case series with chart review conducted in an academic center. From January 1, 2007 to January 31, 2012, we performed surgical treatments for 136 congenital preauricular sinuses on 103 patients aged 0-15 years. We classified the sinuses according to the state of their infection at the time of the surgery intraoperatively--Group I (asymptomatic; n = 68, 50 %), Group II (infected state; n = 26, 19 %) and Group III (infected state with abscess formation; n = 42, 31 %). The surgical outcomes of Groups I, II, and III were documented during an outpatient department observation period. The follow-up period was from 6 months to over 2 years. One patient from Group II and one patient from Group III had a recurrent infection which could be managed by local infection control. One patient from Group I and one patient from Group III had skin defects by necrosis of a skin flap margin which could be secondarily healed. All patients had no recurrence or significant chronic complications. We performed early one-stage surgical treatments on a total of 136 sinuses with an even acute infection with abscess formation and achieved good surgical outcomes, and patients were satisfied in aspects of treatment period and cost. So we present our early one-stage surgical treatment as a good option for infected preauricular sinus management.