What is a preauricular sinus?
A preauricular sinus is a tract that travels under the skin that does not belong there. It is usually accompanied by a small hole located in front of the ear, sometimes called a pit. The pit is usually located just between the face and the cartilage of the ear rim. The tract running underneath the skin can be either short or long and branch out in different directions. If bacteria become trapped within the sinus, a cyst may form under the skin.
A preauricular sinus is congenital, which means your child was born with it. It is most common for only one ear to have a preauricular pit.
Why does my child need a preauricular sinus or cyst removed?
If bacteria gets trapped within the preauricular sinus, your child may develop a cyst and get an infection. Signs of an infection can include swelling, redness and discharge at the pit site. If your child experiences frequent repeated cysts or infections, it is recommended that the preauricular sinus tract be surgically removed. If your child is not prone to infections, the preauricular sinus does not have to be removed.
Risks of preauricular sinus or cyst removal
A preauricular sinus or cyst removal is usually a low-risk procedure. The risk may increase depending on your child’s condition, age and health.
The risks of any cyst removal can include:
- scarring
- the cyst coming back (recurrence)
- infection at the incision site
- improper healing of the incision site (dehiscence)
Giving consent before the procedure
Before the procedure, your child’s ears, nose and throat (ENT) surgeon will go over how and why the procedure is done, as well as the potential benefits and risks. They will also discuss what will be done to reduce these risks, and will help you weigh any benefits against the risks. It is important that you understand all of these potential risks and benefits of the sinus removal and that all of your questions are answered. If you agree to the procedure, you can give consent for treatment by signing the consent form. A parent or legal guardian must sign the consent form for young children. The procedure will not be done unless you give your consent.
How to prepare your child for the procedure
Before any treatment, it is important to talk to your child about what will happen. When talking to your child, use words they can understand. Let your child know that medicines will be given to make them feel comfortable during the procedure.
Children feel less anxious and scared when they know what to expect. Children also feel less worried when they see their parents are calm and supportive.
Food, drink and medicines before the procedure
- Your child’s stomach must be empty before sedation or general anaesthetic.
- If your child has special needs during fasting, talk to your doctor to make a plan.
- Your child can take their regular morning medicine with a sip of water two hours before the procedure.
- Medicines such as acetylsalicylic acid (ASA), naproxen or ibuprofen, warfarin, or enoxaparin may increase the risk of bleeding. Do not give these to your child before the procedure unless they have been cleared first by their doctor.
Will the procedure hurt my child?
Your child will not feel any pain during the procedure. Before the procedure starts your child will be given sleep medicine, also called general anaesthesia.
On the day of the preauricular sinus or cyst removal
When your child arrives at the hospital they will be dressed in a hospital gown and assessed by a nurse. Your child may have an intravenous drip started and may have some freezing cream put on the skin near the sinus pit. You will also be able to speak to the ENT surgeon who will be removing the sinus and the anaesthetist or nurse who will be giving your child medication to make them comfortable during the procedure.
During the preauricular sinus removal, you will be asked to wait in the surgical waiting area.
Your child will have medicine for pain
Children are given medicine for treatments that may be frightening, uncomfortable or painful. This includes sedation and/or general anaesthesia. The procedure will be done while your child is asleep from general anaesthetic.
How is the procedure done?
The ENT surgeon will make an incision around the preauricular pit, and the sinus tract will be removed.
Your child will have stitches that dissolve on their own, as well as adhesive bandage strips that will be later removed by the ENT surgeon.
The procedure will usually take one and a half hours.
What happens after the procedure?
After the procedure, your child will be taken to the recovery room, also called the post-anaesthetic care unit (PACU). This is where your child will wake up. Your child will stay in the recovery room for about one hour. If your child has pain after the procedure, they will receive pain medication, either through an intravenous tube in the arm or by a pill or liquid to swallow.
How soon after the procedure can I see my child?
You will be able to see your child as soon as they are fully awake. A volunteer from the surgical waiting room will bring you to see your child.
Antibiotics
Your child may require antibiotics following the procedure. It is important your child takes their antibiotics according to the prescription. If you are having difficulty getting your child to take them, please call the clinic nurse.
How long will my child stay in the hospital?
Your child will most likely be discharged home the same day as the procedure. Your child’s doctor will let you know when they are well enough to go home.
How should I care for my child at home after the procedure?
Stitches
Your child’s stitches will dissolve on their own. Your child’s ENT surgeon will remove the adhesive bandage strips at your child’s follow-up appointment.
Bathing
Your child can have a bath or shower after their follow-up appointment with the surgeon, which is usually one week after the procedure.
Meals
If your child is feeling well enough after the sedation or anaesthetic, they can return to eating what they normally eat. It is recommended that your child follow any special diet that has been prescribed to them by their primary health-care team. It is also important to encourage your child to drink plenty of fluids for 48 hours after the procedure.
Pain relief
If your child is experiencing pain, you can give them acetaminophen or ibuprofen.
Activity
After the procedure, your child will need to rest and stay home from school or daycare. Make sure they avoid any strenuous physical activity for the first two days (48 hours). Your child may return to school 24-48 hours after the procedure. Do not let your child play contact sports or go swimming until they receive approval from their ENT surgeon.
When will the ENT surgeon see my child again?
The surgical co-ordinator will make a follow-up appointment with the surgeon for your child. This appointment will be approximately one week after the procedure. During this appointment the surgeon will:
- Check your child’s incision site to see how it is healing
- Remove the adhesive bandage strips from the incision site
- Tell you when your child can start to play sports again
When to seek medical attention
Please call your child’s ENT clinic or go to the nearest Emergency Department right away if your child has any of the following signs after going home:
At SickKids
If you are worried about your child’s incision, you can email a photo to entnurses@sickkids.ca.