http://www.NoseSinus.com Dr Kevin Soh, 3 Mount Elizabeth, #07-02, Mount Elizabeth Medical Centre, Singapore 228510 https://www.google.com.sg/maps/place/Dr+Kevin+Soh,+Ear+Nose+Throat+Sinus+Head+%26+Neck+Clinic/@1.3049229,103.8331258,17z/data=!4m5!1m2!2m1!1skevin+soh+review!3m1!1s0x31da1992e3f9ff57:0x61af1e7fa8129600 To understand more about preauricular ear sinus infections, watch this video: http://www.youtube.com/watch?v=M-aUukFk-tY To read a patient's experience with pre auricular sinus: http://www.dotdotslittleshop.com/blog/2013/01/preauricular-sinus-infection-and-how-the-ripas-doctor-managed-to-make-it-even-more-worse/ http://www.dotdotslittleshop.com/blog/2013/01/preauricular-sinus-extracted-tissue/ Dr Kevin Soh explains how a preauricular ear sinus can get infected, and how surgery is performed to resolve the problem. If you have any comments, PLEASE do not be afraid to ask. Please SUBSCRIBE, SHARE, and COMMENT on this video. http://www.NoseSinus.com https://www.google.com.sg/maps/place/Dr+Kevin+Soh,+Ear+Nose+Throat+Sinus+Head+%26+Neck+Clinic/@1.3049229,103.8331258,17z/data=!4m5!1m2!2m1!1skevin+soh+review!3m1!1s0x31da1992e3f9ff57:0x61af1e7fa8129600 3 Mount Elizabeth, #07-02, Mount Elizabeth Medical Centre, Singapore 228510 Dr Kevin Soh explains how enlarged adenoids, block nose, and snoring in children cause ear, lungs, speech and school problems. If you have any comments, PLEASE do not be afraid to ask. Please SUBSCRIBE, SHARE, and COMMENT on this video. If you prefer to read, rather than watch the video, here’s the transcript. 0:17 – Embryology: What is a preauricular sinus? 1) A sinus tract or pit in the preauricular area. 2) It arises because of incomplete fusion of the 6 auricular hillocks that arise from the first and second branchial arches. 0:43 – Case Study: A 21 year old man who had previous surgery for preauricular sinus and cyst but failed to completely eradicate the problem. His ear continues to swell and discharge pus. 0:48 – Surgery video demonstration: The battle lines are drawn. I use a lacrimal probe to determine the extent of the sinus cyst cavity. The sinus seems to be extending quite deep in. After dilating the cyst with the lacrimal probe, I now inject methylene blue to stain the abnormal tissues. I inject lignocaine and adrenaline solution to numb and anaesthetize the area, and to induce vasoconstriction. I now make the incisions. I am using the supra-auricular approach. The supra-auricular approach has a higher success rate when compared to the conventional elliptical incision. The first step is to identify the temporalis muscle fascia. I remove all the infected tissue that is lying superficial to the temporalis fascia. I also get very close to the auricular cartilage in order to remove tissue medial to the auricular cartilage. Studies show that the sinus tract is often closely related to the cartilage and its perichondrium. I will usually remove part of the auricular cartilage. We can see how the injected methylene blue can assist with proper identification of the cyst and its tracts. Quite a large chunk of tissue often has to be removed in order to prevent recurrence of the infection. The specimen shrinks once you take it out of the body. 2:56 – There is now a large cavity which will miraculously fill up and close. I wash the wound with 3% hydrogen peroxide solution. The drain will prevent accumulation of post-operative hematoma and seroma. Then the wound is closed in layers. The suture I am using is about as thin as hair. I cut the drain to the appropriate length. Steristrips are used to cover and protect the wound. An absorbent dressing is used to wick up the secretions coming out through the drain.