Supra-Auricular Approach Transforms Preauricular Sinus Surgery, Suggests Study
A recent retrospective case series published in the Indian Journal of Otology in May 2026 highlights a highly successful surgical treatment for congenital preauricular sinuses. By completely eradicating historically high recurrence rates, the supra-auricular approach delivers a flawless 100% success rate with entirely complication-free clinical outcomes.
While standard sinusectomy procedures historically suffer from troubling recurrence rates ranging between 19 and 42 percent due to complex, microscopic ramifications that are easily missed, Dr. Neenu Anna Joseph, alongside her colleagues at the Al Azhar Medical College and Super Specialty Hospital's Ear, Nose, and Throat (ENT) department, aimed to evaluate the versatility of the supra-auricular approach to bridge this clinical gap and ensure complete en bloc resection.
Therefore, the retrospective case series evaluated 15 patients with congenital preauricular sinuses at a tertiary care center between December 2021 and January 2024. Patients presenting with acute inflammation first received preoperative antibiotics. As the primary intervention, surgeons performed a supra-auricular elliptical incision, utilizing the temporalis fascia as a definitive medial landmark to ensure complete excision. The primary endpoints of surgical success and disease recurrence were then monitored over a minimum six-month follow-up.
Key Clinical Findings of the Study Includes:
• Patient Demographics: Investigators observed a higher prevalence of this congenital condition in males, representing 60 percent of the cohort, with a median patient age of 28 years, contrasting with previous literature that frequently suggested a female predominance.
• Anatomical Variations: Researchers highlighted anatomical diversity, noting the classical preauricular sinus type was present in 73.3 percent of the surgical cohort, while the more complex variant type accounted for the remaining 26.7 percent of documented cases.
• Surgical Involvement: Clinicians found the sinus tract to be directly attached to the auricular cartilage in 80 percent of all patients, heavily emphasizing the absolute necessity for deep, meticulous dissection to avoid leaving residual tissue.
• Clinical Outcomes: Authors achieved a flawless 100 percent success rate, confirming that there were absolutely no disease recurrences or major postoperative complications throughout the follow-up period.
The results suggest that utilizing the temporalis fascia as a reliable deep medial boundary allows for the complete en bloc excision of the entire sinus tract along with any compromised cartilage, effectively eliminating the persistent 19 to 42 percent recurrence risk typically observed in conventional surgical methods.
Thus, the study concludes that clinicians should comfortably consider the supra-auricular approach as a highly versatile and preferred primary surgical option for managing complicated preauricular anomalies, noting its simplicity even for less experienced surgical hands.
While the specific cohort size of the retrospective study might present a modest limitation to making sweeping universal generalizations, it is acknowledged that as clinical research continues to gently evolve, further refining these advanced techniques will undoubtedly contribute to improving surgical outcomes for these affected individuals in the future.
Reference
Joseph NA, Thomas IA, Joy SM, Kaipuzha RR, Pulimoottil DT, Chalil HR. The supra-auricular approach for the management of complicated preauricular sinuses: A retrospective case series. Indian J Otol 2026;32:193-6.
