Pinnae fistula or cyst

Pinnae fistula or cyst, also known as preauricular sinus, preauricular fistula, or preauricular pit, is a common congenital malformation resulting from incomplete or abnormal fusion of the auricular hillocks during embryonic development of the external ear. The condition presents as a small pit, sinus tract, or cyst located typically near the anterior margin of the ascending helix of the ear (pinna). It may be unilateral or bilateral and can occur as an isolated finding or, less commonly, as part of a broader syndrome such as branchio-oto-renal syndrome or other first and second branchial arch anomalies. Most individuals with preauricular sinuses are asymptomatic and the condition is discovered incidentally. However, the sinus tract can become a site of recurrent infection, leading to abscess formation, discharge of purulent or sebaceous material, pain, and swelling in the preauricular region. Repeated infections can cause scarring and chronic drainage. The condition primarily affects the skin and soft tissues surrounding the external ear. Treatment is generally not required for asymptomatic preauricular sinuses. When recurrent infections occur, acute episodes are managed with antibiotics and, if necessary, incision and drainage of abscesses. Definitive treatment involves complete surgical excision of the sinus tract and any associated cyst to prevent recurrence. Surgical excision is recommended after recurrent infections, as incomplete removal can lead to recurrence. Prognosis is excellent following complete excision. In cases where the preauricular sinus is associated with a syndromic condition, evaluation for associated anomalies, particularly renal and hearing abnormalities, may be warranted.

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