[Surgical management and recurrence of congenital preauricular fistula]. / Manejo quirúrgico y recurrencia de la fístula preauricular congénita.

In this paper we describe the surgical management and postoperative recurrence of preauricular fistula (PAF) since the surgical treatment is characterized by high recurrence rates. All clinical, operative and postoperative data were collected from a retrospective review of patients's charts who underwent primary surgical management between January 2001 and December 2006 at five Hospitals in Guadalajara, Jalisco. Thirty-eight patients (15 male, 23 female) with PAF underwent 44 surgical procedures. Recurrent acute infection and discharge were the most common symptoms. The surgical management included 25 standard techniques (sinectomy) and 19 supra-auricular approaches. The overall rate of recurrence was 59%, it differed widely between surgical techniques employed. The 52.2% recurrence rate of standard technique was significantly higher than the 6.8% recurrence rate of the supra-auricular approach (p = 0.01). Also, the patients in whom a portion of the cartilage of the helix was not excised from the base of the tract, 84.6% recurred vs. 15.3% when cartilage was excised (p = 0.01). Our experience has shown that independently of clinical presentation of PAF, the standard technique and not to remove a portion of the cartilage at the base of the helix contributed to recurrence. We advise the supra-auricular approach particularly when there are abscess prior to surgery.

Manejo quirúrgico y recurrencia de la fístula preauricular congénita / Surgical management and recurrence of congenital preauricular fistula

El artículo describe el manejo quirúrgico y recurrencia postoperatoria de la fístula preauricular (FPA) ya que el tratamiento quirúrgico se caracteriza por elevada recurrencia. Los antecedentes clínicos, operatorios y postoperatorios fueron recogidos retrospectivamente de expedientes de pacientes que fueron sometidos a manejo quirúrgico primario de la FPA en cinco hospitales en Guadalajara, Jalisco, durante el periodo de enero 2001 a diciembre 2006. Un total de 44 escisiones de FPA se realizaron en 38 pacientes (15 hombres, 23 mujeres).Infección recurrente y secreción fueron los síntomas más comunes. El manejo quirúrgico incluyó 25 intervenciones con técnica estándar(sinectomía) y 19 abordajes supra-auriculares. La recurrencia global ocurrió en el 59% de las FPA y difirió ampliamente entre las técnicas utilizadas. Con la técnica estándar, la recurrencia fue significativamente elevada 52,2 vs 6,8% resultante mediante el abordaje supraauricular (p= 0,01). También, los pacientes en quienes no se realizó escisión de la raíz del hélix, 84,6% recurrieron vs 15,3% cuando el cartílago fue extirpado (p=0,01). Los resultados muestran que, independientemente de la presentación clínica de la FPA, la técnica estándar y la falta de escisión de la raíz del hélix contribuyeron a recurrencia. Recomendamos el abordaje supra-auricular, en particular en casos con historia de abscesos (AU)

In this paper we describe the surgical management and postoperative recurrence of preauricular fistula (PAF) since the surgical treatment is characterized by high recurrence rates. All clinical, operative and postoperative data were collected from a retrospective review of patients’s charts who underwent primary surgical management between January 2001 and December 2006 at five Hospitals in Guadalajara, Jalisco. Thirty-eight patients (15 male, 23 female) with PAF underwent 44 surgical procedures. Recurrent acute infection and discharge were the most common symptoms. The surgical management included 25 standard techniques (sinectomy) and 19 supra-auricular approaches. The overall rate of recurrence was 59%, it differed widely between surgical techniques employed. The 52.2% recurrence rate of standard technique was significantly higher than the 6.8% recurrence rate of the supra-auricular approach (p = 0.01). Also, the patients in whom a portion of the cartilage of the helix was not excised from the base of the tract, 84.6% recurred vs. 15.3% when cartilage was excised (p = 0.01). Our experience has shown that independently of clinical presentation of PAF, the standard technique and not to remove a portion of the cartilage at the base of the helix contributed to recurrence. We advise the supra-auricular approach particularly when there are abscess prior to surgery (AU)