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May 2004
By Youn W. Park, MD, and Dennis Yee, DO
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CASE:
A nine-year-old boy is brought to your office for pain and
swelling alongside his ear. A review of his history reveals
that there have been scattered recurrences of this problem
following upper respiratory infections. A dimple and erythematous
changes with swelling of the skin are noted in the preauricular
region.
WHAT IS YOUR DIAGNOSIS?
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A preauricular cyst and fistula is congenital, resulting from
a disunion of the hillocks of the first and second branchial
arches forming the auricle. It appears as a small opening in
the skin anterior to the insertion of the helix. The pit-like
depression may lead to a cyst or a tract lined with squamous
cell epithelium under the skin between the helix and the tragus.
It may be unilateral or bilateral. Occasionally, a familial
predisposition can be observed. This anomaly may be difficult
to distinguish from a first branchial cleft anomaly. The fistula
and pit of the latter are usually located below the tragus and
course medially, inferiorly, and posteriorly to the pinna and
concha of the ear. Once the cyst has become infected, complete
surgical removal of the cyst and fistulous tract is necessary
to prevent recurrences. |
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Dr. Park is a clinical professor of otolaryngology
at Northeastern Ohio Universities College of Medicine and
section head of otolaryngology at Barberton Citizens Hospital
in Barberton, Ohio. Dr. Yee is an attending physician in the
department of medicine at Barberton Citizens Hospital.
Emerg Med 36(5):7-8, 2004
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