Outcomes of paediatric preauricular sinus excision – comparison of sinusectomy vs supra-auricular approaches

Introduction Preauricular sinuses are common congenital anomalies that can lead to recurrent infections. Various surgical techniques, including simple sinusectomy and the more extensive supra-auricular approach, are used to excise these tracts. This study aimed to compare the outcomes of sinusectomy vs supra-auricular excision in a paediatric population. Methods A retrospective cohort study was conducted at a tertiary paediatric referral centre. Cases from the period 2009–2025 were identified and clinical records were reviewed. Data were compiled and analysed between the sinusectomy and supra-auricular approaches. Statistical tests were used to identify significance. Multivariable Firth penalised logistic regression was used to assess recurrence according to surgical approach and operative adjuncts. Results A total of 63 patients (71 ears; mean age 6.9 years) were included: 37 (52.1%) underwent sinusectomy and 34 (47.9%) supra-auricular excision. Postoperative complications occurred in 12 of 37 (32.4%) sinusectomy cases vs 4 of 34 (11.8%) supra-auricular cases (odds ratio [OR] 3.6, p < 0.05). Recurrence occurred in 9 of 37 (24.3%) vs 2 of 34 (5.9%) cases, respectively (OR 5.14, p < 0.05). The supra-auricular approach (adjusted OR 0.14, 95% confidence interval [CI] 0.02–0.68) and cartilage excision (adjusted OR 0.20, 95% CI 0.04–0.82) were independently associated with lower recurrence. Conclusions In this paediatric series, supra-auricular excision was associated with lower recurrence and complication rates than sinusectomy. Analysis suggests that cartilage excision may independently contribute to lower recurrence and this association with surgical approach persists after adjustment for operative adjuncts. We recommend the supra-auricular approach as the preferred technique for recurrent or symptomatic preauricular sinuses in children.