Association of Recurrence of Infected Congenital Preauricular Cysts Following Incision and Drainage vs Fine-Needle Aspiration or Antibiotic Treatment: A Retrospective Review of Treatment Options

JAMA Otolaryngol Head Neck Surg. 2017 Feb 1;143(2):131-134. doi: 10.1001/jamaoto.2016.2988.


Importance: Treatment modalities for preauricular sinus tract infections vary. Effort should be taken to decrease methods that lead to increased recurrence after surgical excision.

Objective: To determine whether incision and drainage (I & D) of infected congenital preauricular cysts is associated with increased rate of recurrence when compared with fine-needle aspiration or antibiotic treatment.

Design, setting, and participants: This was a 9-year (2006-2014) retrospective cohort study undertaken at a tertiary care pediatric hospital. Children treated for preauricular sinus tract infections were identified using the procedure code for excision of preauricular pit, cyst, or sinus tract.

Main outcomes and measures: Postexcision recurrence.

Results: Sixty-nine children ranging in age from 4 months to 17 years (mean age, 5.9 years) underwent excision of a preauricular cyst. Thirty-seven of 69 patients (54%) were female. Fifty-seven of 69 (83%) had a preoperative history of infection; the remainder had chronic drainage. Of children with preoperative infection, 27 were initially treated with incision and drainage (I & D), 12 were treated with fine-needle aspiration only, and 18 received antibiotic therapy alone. Overall, the recurrence rate was 8 in 69 (11.6%). Among the 27 patients with a preoperative history of infection treated with I & D, 5 lesions (18.5%) recurred, and among those who only received preoperative antibiotic therapy or fine-needle aspiration 1 in 30 lesions (3.3%) recurred (absolute difference of 15.2%; 95% CI, -1.7% to 33.6%).

Conclusions and relevance: Among infants and children undergoing excision of preauricular cysts, a history of infection was not associated with a higher recurrence rate. There was, however, evidence to suggest that a higher rate of recurrence exists among children who had a preoperative history of infection treated with I & D. Our results suggest a more conservative treatment of infected preauricular pit and/or sinus.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / therapeutic use*
  • Biopsy, Fine-Needle*
  • Child
  • Child, Preschool
  • Craniofacial Abnormalities / drug therapy*
  • Craniofacial Abnormalities / microbiology
  • Craniofacial Abnormalities / surgery*
  • Drainage*
  • Female
  • Humans
  • Infant
  • Male
  • Recurrence
  • Retrospective Studies
  • Treatment Outcome


  • Anti-Bacterial Agents

Supplementary concepts

  • Preauricular Fistulae, Congenital