A systematic review on the surgical outcome of preauricular sinus excision techniques

• Published in: The Laryngoscope 2016-07, Vol.126 (7), p.1535-1544
• Main Authors: Bruijnzeel, Hanneke, van den Aardweg, Maaike T., Grolman, Wilko, Stegeman, Inge, van der Veen, Erwin L.
• Format: Article
• Language: English
• Subjects: Clinical outcomes; Confidence intervals; Cutaneous Fistula - congenital; Cutaneous Fistula - surgery; Drainage - methods; Ear Auricle - abnormalities; Ear Auricle - surgery; ear diseases; Ear Diseases - congenital; Ear Diseases - surgery; External ear; Humans; Microscopy - methods; operative; Recurrence; surgical procedures; Treatment Outcome
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.25829

Objectives/Hypothesis Preauricular sinuses are benign congenital malformations of preauricular soft tissues. Complete excision using either sinectomy or supra‐auricular approach is advised to prevent recurrence. Reported recurrence varies between 0 and 42%. We evaluated which surgical technique resulted in lowest complication and recurrence rates. Study Design PubMed, Embase, Scopus, Web of Science. Methods Two authors appraised studies on directness of evidence and risk of bias. Original data were extracted and pooled when I2 was smaller than 50%. Results are reported according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement. Results Fourteen high directness of evidence studies were included. Reported complication rates were similar: sinectomy [0–31.4%] and supra‐auricular approach (SAA) [0–18.2%]. Pooled recurrence rates showed that sinectomy resulted in significantly (P = .04) more recurrence 5.5% (95% confidence interval [CI] 3.6–8.3%) than SAA 2.2% (95% CI 0.7–7.0). Sinectomy using the microscope resulted in the lowest sinectomy recurrence rates (1.9%). SAA in combination with a Penrose drain resulted in 0% recurrence in revision cases. Drain use resulted in the lowest SAA recurrence rates; however, drain application was not advised due to higher complication rates (frequent wound infection [P = .003] and more [P = .002] and longer [P = .001] compression dressing use). Conclusion SAA could be the preferable technique for preauricular sinus removal. If despite evidence, sinectomy is elected over SAA, microscope use can further decrease recurrence rates comparable to SAA levels. Level of included evidence (Ib–IV) indicates the need for a prospective study comparing surgical outcomes between techniques. Laryngoscope, 126:1535–1544, 2016