![]() After trimming the flap to fit the defect, the first suture is placed at the tip of the flap and secured to the remaining helix with a vertical mattress suture to allow good eversion and avoid notching of the rim. ![]() Because the postauricular skin is thin, undermining should be done with care. A burrow triangle is added to the flap to allow easy closure of the secondary defect by tapering the tip of the secondary defect. The flap is designed to have a length-to-width ratio of 1:4 (exceeding the length of the defect). The anterior edge of the flap is cut along the retroauricular sulcus. To reconstruct a similarly sized defect, a postauricular transposition flap can be performed as a single-stage procedure. For helical defects greater than 2.5 cm, a multistaged tubed flap (anterior or posterior) is considered. However, when the defect is 1.5-2.5 cm, the best choice is helical advancement flap. When defects are smaller than 1.5 cm, wedge conversion of the defect followed by primary closure is aptly suited without distortion of the anatomy. Reconstruction of the upper one third of the ear may be achieved using several strategies such as full-thickness skin grafts, wedge resection with subsequent primary closure, helical advancement flaps, multistage preauricular or postauricular tubed flaps, and one-stage preauricular or postauricular transposition flaps. A good clinical assessment is the key in terms appropriate investigation and long term outcome for these patients.The banner flap is taken behind the superior aspect of the ear. Fine needle aspiration is not always possible in children and is not recommended as an initial investigation. Further diagnostic work up include an initial assessment by an experienced Paediatric ENT surgeon with Ultrasound or MRI scanning. ![]() Other common lesions in this area include Dermoid cyst, Parotid cyst or tumours, Pilomatrixomas, MAIC (non-tuberculous -mycobacterial avian intraccellure complex) infection, keloid scar secondary to ear piercing and Lymphatic /vascular lesions (especially in young children). ![]() However, not too infrequently other cysts/lumps can present in this vicinity which can be misdiagnosed as a simple preauricular cyst or preauricular sinus infection. Risks related to the surgery are minimal as there are no major structures around this area apart from some small vessels but complications such as haematoma (blood clot at the site of surgery), secondary infection, and wound healing dehiscence can occur. Surgical removal is straight forward and is performed under a general anaesthetic, takes approximately 45 -60 minutes. It is well accepted that once you have had one of these infections, it is more likely you will have infective episodes in future (50% chance) therefore we would usually advise removing the sinuses to prevent further infections and long term cosmetic deformity due to repeated infections, abscess formation and old incision and drainage scars. This may require a general anaesthetic to drain the abscess. Frequently these infections/ abscesses may need drainage. In most instances surface cleaning of the sinus, opening and clearing any blockage or if infected treating with antibiotics may be sufficient to prevent further flare-ups of infections. In some young children and in the adolescent population the preauricular sinus can become infected and either cause a cyst formation or abscess. Majority of these sinuses do not need any intervention and can often go unnoticed. The tract can produce debris, mucus and flaking squamous material from the skin lined epithelium, and this has the potential for infection when the sinuses are blocked. The sinuses are blind-ending pockets which connect to the deeper part of the ear canal. It is a common problem in many individuals and is estimated that up to 3% of the population may have the sinuses in the upper part of the ear (superior part of the auricle). Preauricular sinus/cysts are caused by an embryological hillocks fusion abnormality when the outer ear is formed around 8-12 week intrauterine life.
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