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Original Investigation
February 2017

Association of Recurrence of Infected Congenital Preauricular Cysts Following Incision and Drainage vs Fine-Needle Aspiration or Antibiotic TreatmentA Retrospective Review of Treatment Options

Author Affiliations
  • 1Department of Otolaryngology, Walter Reed National Military Medical Center, National Capital Consortium, Washington, DC
  • 2Division of Otolaryngology, Children's National Medical Center; Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, Washington, DC
JAMA Otolaryngol Head Neck Surg. 2017;143(2):131-134. doi:10.1001/jamaoto.2016.2988
Key Points

Question  Is incision and drainage of infected congenital preauricular cysts associated with increased rate of recurrence when compared with fine-needle aspiration (FNA) or antibiotic treatment?

Finding  In a cohort study of children with a history of preoperative infection, an increase in recurrence was found in patients undergoing preoperative incision and drainage when compared with patients treated with FNA or antibiotics alone.

Meaning  These results guide the practitioner toward more conservative treatment modalities, such as oral antibiotics or FNA, and avoidance of incision and drainage for initial management.

Abstract

Importance  Treatment modalities for preauricular sinus tract infections vary.  Effort should be taken to decrease methods that lead to increased recurrence after surgical excision.

Objective  To determine whether incision and drainage (I & D) of infected congenital preauricular cysts is associated with increased rate of recurrence when compared with fine-needle aspiration or antibiotic treatment.

Design, Setting, and Participants  This was a 9-year (2006-2014) retrospective cohort study undertaken at a tertiary care pediatric hospital. Children treated for preauricular sinus tract infections were identified using the procedure code for excision of preauricular pit, cyst, or sinus tract.

Main Outcomes and Measures  Postexcision recurrence.

Results  Sixty-nine children ranging in age from 4 months to 17 years (mean age, 5.9 years) underwent excision of a preauricular cyst. Thirty-seven of 69 patients (54%) were female. Fifty-seven of 69 (83%) had a preoperative history of infection; the remainder had chronic drainage. Of children with preoperative infection, 27 were initially treated with incision and drainage (I & D), 12 were treated with fine-needle aspiration only, and 18 received antibiotic therapy alone. Overall, the recurrence rate was 8 in 69 (11.6%). Among the 27 patients with a preoperative history of infection treated with I & D, 5 lesions (18.5%) recurred, and among those who only received preoperative antibiotic therapy or fine-needle aspiration 1 in 30 lesions (3.3%) recurred (absolute difference of 15.2%; 95% CI, −1.7% to 33.6%).

Conclusions and Relevance  Among infants and children undergoing excision of preauricular cysts, a history of infection was not associated with a higher recurrence rate. There was, however, evidence to suggest that a higher rate of recurrence exists among children who had a preoperative history of infection treated with I & D. Our results suggest a more conservative treatment of infected preauricular pit and/or sinus.

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