Association of preauricular sinuses and renal anomalies

doi:10.1016/0090-4295(92)90487-H

Urology

Volume 40, Issue 3, September 1992, Pages 259-261

https://doi.org/10.1016/0090-4295(92)90487-H Get rights and content

Abstract

Renal ultrasonography was performed on 69 children who had a preauricular sinus. Three children (4.3 %) were found to have a significant renal anomaly. Two children had hydronephrosis secondary to vesicoureteric reflux. One patient with branchio-oto-renal syndrome had an absent left kidney and a hypoplastic right kidney associated with two dysplastic arteries. Renal anomalies were significantly more common in patients with a preauricular sinus than the 1 percent incidence of renal anomalies reported in the general population. We recommend that renal ultrasonography be performed on all children with a preauricular sinus.

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Cysts and fistulae of the face and neck in children are formed before birth and correspond to the persistence of embryonic remnants that occur due to coalescence defects of embryonic buds or due to epidermal inclusion. They represent the most common pathological malformation of the face and neck. They may be separated according to their location into laterocervical cysts and fistulas or median cysts and fistulas. Their discovery may occur prematurely at birth or later during growth or in adulthood. Their treatment always requires surgical excision, which must be complete in order to prevent recurrences.
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The preauricular sinus is a not uncommon finding in the paediatric population. Recent reports have added to our knowledge of this benign malformation. We review the current literature with respect to the aetiology of the condition, its clinical features, and associations with other congenital malformations. In those patients in whom a preauricular sinus is identified, we recommend associated congenital anomalies be sought. In selected cases, a renal ultrasound scan may be appropriate. Where no associated abnormalities are identified, and where the preauricular sinus is asymptomatic, there is consensus opinion that no further action is indicated. In the acute phase of infection, treatment comprises administration of appropriate antibiotics, and incision and drainage of an abscess if present. In the symptomatic preauricular sinus exhibiting recurrent or persistent infection, opinion regarding optimal management varies. Latest evidence suggests definitive surgical treatment offering the most favourable outcome is by wide local excision of the sinus, as opposed to the previously preferred technique of simple sinectomy. Magnification employed during surgery, and opening, and following from the inside as well as outside, branching tracts of the sinus may further minimise the risk of recurrence.
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Citation Excerpt :
Reported recurrence rates are less than 5%.9,11 Most authors obtain better results, irrespective of the technique they use, when they include a part of cartilage (root of the helix/tragus/auditory canal) in the resection.5,7,9 The dissection with the inside-out technique is facilitated by the fact that the different aspect of the lining of the tract helps to identify even the smallest tracts, especially while one is working with magnification.
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The inside-out technique provides an easy solution for patients with PAS. However, further study on a larger patient group is necessary.
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Because preauricular skin tags and ear pits are associated with permanent hearing impairment in newborns, screening and close monitoring are warranted.22 There is a known association between ear and renal abnormalities, and a variety of syndromes demonstrate both ear and renal defects.23–25 In the past, there was uncertainty about which ear malformations warranted screening renal ultrasonography.
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Association of preauricular sinuses and renal anomalies

Abstract

J Pediatr

Hals-Kiemen-Fisteln von noch nicht beobachteter Form

Virchows Arch [A]

Malformation of ears as sign of malformation of genitourinary tract

Br Med J

Congenital malformations

Fistula auris congenita

Am J Dis Child

Congenital sinuses of the external ear

J Laryngol