PERIAURICULAR CYSTS AND SINUSES

Periauricular cysts, sinuses, and fistulas occur commonly in the pedia tric population. They arise from developmental defects of the first br anchial cleft and first branchial arch. In most instances the diagnosi s and management of these conditions are straightforward, but exceptio nal presentations sometimes occur. Failure to recognize these unusual cases may result in inadequate treatment and subsequent recurrence, an d even if the correct diagnosis is made, surgical management of these lesions may be complicated. A series of 15 cases of periauricular cong enital lesions is reviewed, of which three cases illustrating a diagno stic or surgical challenge are presented. The embryology, presentation , and management of these anomalies are discussed. This is one of the largest series of first branchial cleft anomalies reported in the lite rature, and our paper uniquely discusses first branchial cleft anomali es and preauricular sinuses together, with an emphasis on the surgical management of facial nerve, external ear, and middle ear involvement.