From the Guidelines
Preauricular treatment should prioritize managing potential complications from ear piercings, with a focus on preventing infections and promoting proper wound care, as complications can occur in up to 35% of individuals with ear piercings 1. When considering preauricular treatment, it's essential to recognize the potential risks associated with ear piercings, including minor infections, allergic reactions, keloid formation, and traumatic tearing 1.
- Auricular perichondritis and perichondrial abscess typically occur in the first month after piercing, especially during warm-weather months, and can be managed with fluoroquinolone antibiotic treatment, such as ciprofloxacin or levofloxacin 1.
- If an abscess is present, surgical incision and drainage may be necessary to prevent further complications and promote healing 1.
- To prevent embedding of earrings, using longer earring posts with adjustable backings is recommended, especially for individuals with thick, fleshy earlobes 1.
- In cases of trauma to the pierced external ear, wounds should be cleaned and repaired within 12 to 24 hours, and a simple earlobe tear can be sutured under local anesthesia 1.
- Contact dermatitis resulting from nickel exposure is common, and avoidance of the metals that trigger a reaction, along with the application of topical corticosteroids, can help resolve allergic dermatitis 1. The most critical aspect of preauricular treatment is preventing infections and promoting proper wound care, as complications can have a significant impact on morbidity, mortality, and quality of life 1.
From the Research
Preauricular Sinus Treatment
- The preauricular sinus is a common congenital abnormality that can become infected, and treatment options vary depending on the severity of the infection 2.
- Infected preauricular sinuses can be treated with oral antibiotics, needle-aspiration, and/or incision and drainage to control the infection prior to surgery 3.
- Recurrent infection is a clear indication for complete excision, which provides the only definitive cure, with recurrence rates after surgery ranging from 9% to 42% 2.
- Meticulous excision by an experienced head and neck surgeon minimizes the risk of recurrence, and techniques such as wide local excision of the sinus and the use of magnification during surgery can further reduce the risk of recurrence 4.
Management of Infected Preauricular Sinuses
- Treatment modalities for preauricular sinus tract infections vary, and efforts should be taken to decrease methods that lead to increased recurrence after surgical excision 5.
- Incision and drainage (I & D) of infected congenital preauricular cysts may be associated with an increased rate of recurrence when compared with fine-needle aspiration or antibiotic treatment 5.
- A more conservative treatment of infected preauricular pit and/or sinus, such as fine-needle aspiration or antibiotic therapy, may be preferred to reduce the risk of recurrence 5.
- Complete excision of the sinus is the only definitive cure, and failure to recognize the presence of a sinus may lead to inadequate management and unnecessary surgery 6.
Surgical Technique
- A safe and reliable technique for complete removal of the preauricular sinus involves wide local excision of the sinus, with magnification employed during surgery to minimize the risk of recurrence 4.
- Opening and following the branching tracts of the sinus from the inside as well as the outside can further minimize the risk of recurrence 4.
- A lack of awareness of the presence of a sinus and identification of a preauricular pit by the inexperienced clinician can result in inadequate treatment and potentially unnecessary surgical procedures 6.