Managing Suppurative Preauricular Sinus in Children Before Surgery

The preauricular sinus has become infected?

Hello, my child is scheduled for surgery to remove something on November 20, but has developed an abscess that is nearly one centimeter in size on November 13.
Should we drain it first, or can the surgery address it at the same time?

Hua Hua, 30~39 year old female. Ask Date: 2020/11/15

Dr. Ji Zhaoyun reply Otolaryngology

Hello, based on your description, it may be advisable to initially use antibiotics and other medications to wait for the infection to subside before proceeding with surgery.
However, if the infection is too severe, it may be necessary to first perform an incision and drainage to alleviate the infection.
It is important to note that completely excising the fistula during the infection period can be quite challenging.
It is recommended to discuss this with the surgeon.
Wishing you safety and good health.

Reply Date: 2020/11/15

More Info

Managing a suppurative preauricular sinus in children, especially when surgery is planned, requires careful consideration of the current state of the infection and the timing of the surgical intervention. In your case, with your child experiencing a significant infection just days before the scheduled surgery, there are a few important factors to consider.

Firstly, a suppurative preauricular sinus indicates that there is an active infection, which can complicate surgical procedures. If the sinus is infected and has formed an abscess (as suggested by the size of nearly one centimeter), it is generally advisable to address the infection before proceeding with the planned surgery. This is because performing surgery on an infected site can increase the risk of complications, such as poor wound healing, increased pain, and the potential for the infection to spread.

In many cases, the initial step would be to perform an incision and drainage (I&D) of the abscess. This procedure can help relieve the pressure caused by the accumulation of pus and can also allow for better visualization of the sinus tract during the subsequent surgical procedure. By draining the infection, you can also reduce the bacterial load, which may lead to a more favorable surgical outcome when the definitive surgery to excise the sinus is performed.

Once the infection is adequately managed, and the child is stable, the surgical excision of the preauricular sinus can be performed. It is crucial to ensure that the child is free from signs of systemic infection (such as fever or significant malaise) before proceeding with the surgery. The timing of the surgery may need to be adjusted based on the resolution of the infection, which can typically take several days to a week, depending on the severity of the infection and the child's response to treatment.

In terms of anesthesia, if the child requires drainage and subsequent excision, general anesthesia is often preferred in pediatric cases, especially for younger children who may not cooperate during the procedure. This ensures that the child remains still and comfortable throughout the surgery.

It is also important to follow up with the pediatric otolaryngologist or surgeon managing your child's case. They will provide specific recommendations based on the clinical evaluation of the infection and the overall health of your child. They may also consider the use of antibiotics to help manage the infection before surgery.

In summary, it is advisable to address the infection in the preauricular sinus through drainage before proceeding with the planned surgical excision. This approach minimizes the risk of complications and promotes better healing outcomes. Always consult with your child's healthcare provider for personalized medical advice tailored to your child's specific situation.

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