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Inflammatory disorders of the ear, nose, sinuses and throat
Preauricular sinus is a common congenital condition; there is no requirement for treatment unless it becomes infected (Figure 18.1). It may then present with pain, swelling and discharge. If seen at an early stage, infected preauricular sinus may be controlled with antibiotics. If a patient presents with a preauricular abscess, incision and drainage together with antibiotic will then become necessary. The site of incision should be through the sinus opening so as to minimize branching of the sinus tract. This is particularly important with recurrent preauricular abscesses. Abscess formation or recurrent infections are indications that the sinus tract should be excised. It is important that all tracts connected to the sinus should be excised to prevent recurrence. If in doubt, any soft tissue adherent to the tract should be excised as deep as the temporalis fascia.
The pinna, because of its exposed and protruding position, is frequently traumatized. Blunt injury may lead to formation of an auricular haematoma. The haematoma typically forms in the subperichondrial plane. If treatment is delayed, the haematoma may dissect along the subperichondrial plane and result in unsightly deformity. Thus auricular haematoma needs to be evacuated promptly and a pressure dressing applied to conform with the shape of the pinna by means of through and through stitches.
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