What is the first step in the surgical procedure for excising a preauricular sinus?
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Make a vertical elliptical skin incision around the sinus opening.
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What is the first step in the surgical procedure for excising a preauricular sinus?
Make a vertical elliptical skin incision around the sinus opening.
What should be done if the superficial temporal artery and vein are lacerated during surgery?
Bleeding can be controlled by ligating the vessel(s).
What surgical approach is discussed in the study by Leopardi G et al.?
Supra-auricular approach for the surgical treatment of recurring preauricular sinus.
What type of epithelium lines excised preauricular sinuses?
Stratified squamous epithelium.
What forms the deepest plane of dissection in ear surgery?
Temporalis fascia.
What technique can be used to dissect down to the temporalis fascia?
Sharp dissection or electrocautery.
What risk is associated with misdiagnosing a 1st branchial cleft remnant as a preauricular sinus tract?
It may place the facial nerve at risk.
What is the origin of the external auditory meatus?
It is derived from the 1st branchial cleft.
What are preauricular pits and sinuses?
Congenital anomalies located in or just in front of the ascending limb of the helix.
What is the risk associated with the frontal branch of the facial nerve during surgery?
Injury if the surgeon strays anteriorly during resection.
What technique is sometimes advocated to assist in identifying the sinus tract?
Injecting methylene blue into the cyst or sinus.
What should be done before contemplating surgery for an abscess?
The abscess should first be aspirated with a needle and treated with antibiotics.
What should be done after resecting the specimen?
Irrigate the wound.
What can happen if the auricular hillocks do not fuse completely?
They may leave sinuses between them.
What anatomical structures must a surgeon be familiar with during the excision of preauricular sinuses?
Facial nerve, superficial temporal artery, and auricular cartilage.
When is CT or MRI imaging indicated for preoperative investigations?
When a sinus is atypically located or a branchial cleft remnant is suspected.
Why do some advocate for the removal of a small portion of auricular cartilage during excision?
To ensure thorough excision and reduce recurrence rates.
What may be left in situ after the procedure?
A small drain.
What types of tissues are present in the specimen described?
Skin (S), soft tissue containing preauricular sinus (ST), and cartilage (C).
What may preauricular pits discharge?
Desquamated keratin debris.
What genetic trait is associated with preauricular sinuses?
Autosomal dominant trait with incomplete penetrance and variable expression.
When is surgery indicated for preauricular sinuses?
When complicated by recurrent infection or abscesses.
What should be done after identifying the cartilage of the helix?
Dissect along the cartilage, keeping deep to the perichondrium.
What is a common issue if an adequate resection of a preauricular sinus is not done?
Recurrence of the sinus.
What is the surrounding tissue of excised sinuses indicative of?
Chronic inflammation.
What should be noted when extending the incision into the supra-auricular area?
The position of the facial nerve.
What is a potential issue with using a lacrimal probe during surgery?
It may cause a false tract and cannot identify small branches.
What is a possible cause of the folding of ectoderm during auricle development?
It may be the cause of incomplete fusion of the hillocks.
What is the incidence of preauricular sinuses in parts of Africa?
As high as 10%.
What is the histologic distance between excised preauricular epithelial sinus tracts and adjacent auricular cartilage in over 50% of cases?
Less than 0.5 mm.
What are the steps taken to reduce recurrence in sinus surgery?
Operate under optimal conditions, completely excise the sinus tract with surrounding tissue, and ensure wide exposure.
What is the recommended incision approach for sinus surgery?
Supra-auricular extension of the preauricular incision.
What is the result of excising the slither of cartilage?
A surgical defect at the apex of the preauricular sinus.
Where do preauricular sinuses/cysts typically lie in relation to the facial nerve?
Superior and lateral to the facial nerve and parotid gland.
What syndrome may be associated with preauricular sinuses?
Branchio-oto-renal syndrome.
What should not be confused with a preauricular cyst?
A 1st branchial cleft remnant.
What is the focus of the study by Dunham B et al. referenced in the document?
The histologic relationship of preauricular sinuses to auricular cartilage.
Where are the most common sinuses located if the hillocks do not fuse?
Between the tragus and root of the helix, or between the antihelix and helix.
Which side are preauricular pits more commonly found?
More common on the right side, but may be bilateral.
What is the deep boundary during the dissection?
Temporalis fascia.
In which direction should the soft tissues be dissected off the temporalis fascia?
In a posteroinferior direction.
What should be avoided during general anesthesia to detect facial nerve stimulation?
Muscle paralysis.
From which branchial arches do the auricular hillocks originate?
Numbers 1-3 originate from the 1st branchial arch and 4-6 from the 2nd arch.
What developmental issue can arise from anomalous development of hillocks 1-3?
It may cause supernumerary hillocks and preauricular tags.
What is the posterior boundary during the resection of subcutaneous tissue?
Auricular cartilage.
What is the reported recurrence rate following simple sinusectomy?
Up to 40%.
What is the purpose of excising a slither of cartilage during the procedure?
To ensure complete removal of the preauricular sinus.
How should the wound be closed after the procedure?
Suture the wound in layers.
What is the first step in the dissection process described?
Dissecting along the temporalis fascia up to the cartilage of the helix.
What is being excised at the apex of the sinus tract?
A slither of helical cartilage.
What does the final part of the dissection include?
An island of helical cartilage.
