Author(s)
Glenn Isaacson, MD
Affiliation(s)
Lewis Katz Sch. of Med. at Temple Univ., Meadowbrook, PA.
Abstract:
Introduction:
Objective: To review single-surgeon 16-year experience with management of infected preauricular pit/cysts
Methods:
Design: Computerized search of all office notes and operative reports during the years 2001-2017
Setting: Academic medical center and suburban office practice
Participants: Children from 0-18 years of age with symptomatic preauricular pit/cysts
Intervention: Children with symptomatic preauricular pit/cysts underwent surgical excision. Those presenting with infected cysts were treated with oral antibiotics, antibiotic prophylaxis, needle aspiration and/or incision and drainage to control infection prior to surgery.
Main Outcome Measure: Control of infection without recurrence following surgery
Results: 415 patient encounters involved pre-auricular pit/cysts. These ultimately led to 56 surgical excisions. 28 of the pit/cysts were infected at presentation. All infected lesions were treated with oral antibiotics and 7 received antibiotic prophylaxis until surgery (mean duration 6 weeks). 6 abscessed cysts were controlled by needle aspiration. 2 abscesses required incision and drainage. 1 abscess could not be controlled by either drainage technique and was surgically excised while actively infected. 3 pit/cysts recurred at 2 months, 2 years and 10 years after surgery respectively – 2 of these had been infected. All were control with subsequent en bloc resection.
Conclusion: Surgical treatment of infected preauricular pit/cysts remains controversial. All long-term series include some recurrences. Control of infection prior to definitive surgery is desirable, but not mandatory. Preauricular abscesses with spontaneous rupture can be managed by pit/cyst excision without resection of the abscess wall or overlying skin. This leads to excellent control and superior cosmesis.