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Objectives/hypothesis: Preauricular sinuses are benign congenital malformations of preauricular soft tissues. Complete excision using either sinectomy or supra-auricular approach is advised to prevent recurrence. Reported recurrence varies between 0 and 42%. We evaluated which surgical technique resulted in lowest complication and recurrence rates., Study Design: PubMed, Embase, Scopus, Web of Science., Methods: Two authors appraised studies on directness of evidence and risk of bias. Original data were extracted and pooled when I(2) was smaller than 50%. Results are reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement., Results: Fourteen high directness of evidence studies were included. Reported complication rates were similar: sinectomy [0-31.4%] and supra-auricular approach (SAA) [0-18.2%]. Pooled recurrence rates showed that sinectomy resulted in significantly (P = .04) more recurrence 5.5% (95% confidence interval [CI] 3.6-8.3%) than SAA 2.2% (95% CI 0.7-7.0). Sinectomy using the microscope resulted in the lowest sinectomy recurrence rates (1.9%). SAA in combination with a Penrose drain resulted in 0% recurrence in revision cases. Drain use resulted in the lowest SAA recurrence rates; however, drain application was not advised due to higher complication rates (frequent wound infection [P = .003] and more [P = .002] and longer [P = .001] compression dressing use)., Conclusion: SAA could be the preferable technique for preauricular sinus removal. If despite evidence, sinectomy is elected over SAA, microscope use can further decrease recurrence rates comparable to SAA levels. Level of included evidence (Ib-IV) indicates the need for a prospective study comparing surgical outcomes between techniques. Laryngoscope, 126:1535-1544, 2016., (© 2016 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: To outline two cases of congenital tracheocutaneous fistula and discuss the potential pathogenesis of this previously unreported developmental abnormality., Methods: Two cases of tracheocutaneous fistula evaluated at John Peter Smith Hospital (Fort Worth, TX) from May to October 2001 were reviewed. The surgical treatment of one infant is described., Results: Two infants were evaluated with a congenital fistula extending from the suprasternal region of the neck dorsally to the trachea in the midline. The infants were otherwise developmentally normal with unremarkable prenatal histories. Primary surgical closure of a fistula was accomplished without complication., Conclusions: Congenital tracheocutaneous fistula appears to be an isolated developmental abnormality not associated with the same degree of morbidity as acquired tracheocutaneous fistula. The development of a congenital tracheocutaneous fistula may be the result of abnormal epidermal migration secondary to a localized midline mesodermal defect. Congenital tracheocutaneous fistula may be successfully treated with primary closure. Observation and close follow-up of asymptomatic fistulas may be reasonable.

A 30-year-old male presented with multiple, yellowish to skin-colored, firm to soft nodules on the forehead, temple, postauricular area and neck for the previous seven years. Examination of the scalp revealed a single, soft, cystic swelling on the occiput and the patient complained of occasional discharge from two, 0.1 x 0.1 cm, openings in front of both ears. Histopathology of the facial lesion was suggestive of steatocystoma multiplex, while that of the scalp revealed a pilar cyst. An otorhinolaryngeal evaluation confirmed the presence of bilateral pre-auricular sinus. We present this previously unreported pilosebaceous hamartoma, constituting facial steatocystomas and pilar cyst, associated with bilateral preauricular sinus.