Cystic lesions near or around the external auditory canal are believed to represent first branchial cleft duplication anomalies, classified by Work as Type I or Type II. Tracts arising from (Type I) or paralleling (Type II) the external auditory canal can lead to a cystic cavity, which will become recurrently infected and often drain in or near the ear. Other anomalies associated with faulty first cleft development include: pits of the lower lip; clefts of the middle chin and ear lobe; preauricular sinuses and tags; cervical tags and dermoid cysts; atretic, stenosed or malformed external auditory canals; and double or congenitally perforated T.M. Sinus tracts paralleling the EAC, or arising from it, are also well recognized first branchial cleft anomalies.
Pre-auricular cysts connect to the outside with a sinus tract that opens into a pit, just anterior to the root of the helix. Occasionally, foul smelling material oozes out of the pit.
Infected pre-auricular cyst in a child. This was treated with antibiotics and excised at a later date.
The sinus tract and cyst are excised, after outlining them with an injection of methylene blue into the pit.
The picture to the left shows an infected preauricular cyst that had been incised and drained. In order to excise this cyst, it was allowed to "refill" prior to definitive surgery.
