Preauricular Sinus Surgery in Singapore

Preauricular sinus surgery involves the removal of an abnormal tract or channel near the front of the ear, which occurs due to developmental changes before birth.

The procedure eliminates the sinus tract and surrounding tissue to prevent recurring infections and discharge while preserving the natural ear appearance.

Dr Gan Eng Cern

Ear, nose and throat specialist

MBBS

MRCS (Edin)

mmed (orl)

FAMS

Benefits Techniques Preparation Procedure Recovery Risks FAQ

Indications for Surgery

When determining the need for preauricular sinus surgery, our clinic carefully evaluates the following key factors:

Recurrent Infections: Frequent infections of the sinus tract, often associated with discharge, swelling, pain, and difficulty in managing symptoms.
Chronic Drainage: Persistent fluid discharge from the sinus opening, which can lead to irritation, hygiene challenges, and social discomfort.
Abscess Formation: Painful pus-filled collections around the sinus tract that often require repeated drainage procedures or antibiotic courses.
Failed Conservative Treatment: Continued symptoms and complications despite attempts at non-surgical treatments, such as antibiotics or wound care.

Benefits of Preauricular Sinus Surgery

Surgical treatment for a preauricular sinus provides several benefits, including:

Infection Prevention: Complete removal of the sinus tract eliminates the underlying cause of recurrent infections and associated symptoms.
Cosmetic Improvement: The procedure removes visible sinus openings and discharge, restoring a more natural and aesthetic appearance of the ear.
Reduced Healthcare Needs: Resolving the condition reduces the frequency of medical visits and reliance on antibiotics.

Surgical Techniques

Surgeons employ different approaches based on the sinus tract’s complexity and extent:

Simple Sinectomy: This basic technique involves excision of the sinus opening and main tract. The surgeon makes an elliptical incision around the sinus opening and follows the tract to remove it completely. This method suits cases with straightforward, single tracts.

Modified Inside-Out Technique: The ENT surgeon injects methylene blue dye into the tract to highlight its path, then dissects from the opening inward while following the stained tissue. This approach allows for better visualisation and complete removal of branching tracts.

Supra-auricular Approach: This technique uses an incision above the ear to access the entire sinus tract system. The surgeon creates a larger exposure area to ensure complete removal of all branches and prevent recurrence. This method particularly suits complex or previously operated cases.

Preparing for Surgery

Medical Evaluation: The surgeon examines the preauricular area to map the sinus tract extent. Imaging studies may be performed to identify tract branches and depth. Blood tests assess general health status and infection markers.
Medication Adjustments: Patients must stop blood-thinning medications 7-10 days before surgery. Active infections require antibiotic treatment before scheduling surgery. The surgeon reviews and adjusts all current medications.
Pre-operative Guidelines: Patients are required to fast for 6 hours before surgery if general anaesthesia is planned. Hair near the surgical site requires cleaning and may need partial trimming. Specific instructions about arrival time and post-operative care are provided.

Step-by-Step Procedure

Anaesthesia Administration

The procedure begins with the administration of either local or general anaesthesia, depending on the patient’s condition and the complexity of the surgery. For local anaesthesia, a numbing solution containing lidocaine and epinephrine is injected around the sinus area to reduce pain and control bleeding. Studies have shown that preauriucular sinuses that are excised under general anaesthesia reduces the risk of recurrences.

Tract Identification

To locate the sinus tract, the surgeon will use a microscope during surgery. Some surgeons will inject methylene blue dye into the sinus opening, highlighting its path. A probe may also be used to determine the direction and any branches of the tract. These steps ensure the entire tract is accurately visualised.

Surgical Excision

The surgeon makes an incision around the sinus opening and carefully dissects the tissue. This is often done under microscope guidance. Following the dyed tract, all affected tissue is removed, ensuring complete excision. Care is taken to avoid damaging surrounding structures.

Closure

After excision, the wound is thoroughly irrigated with an antibiotic solution to reduce infection risk. The deeper layers are closed with absorbable sutures, while the skin is sutured with non-absorbable stitches. A pressure dressing is then applied to prevent fluid build-up and support healing.

Post-Surgical Care and Recovery

Immediate Post-operative Care: After surgery, patients are closely monitored for bleeding and pain control. A pressure dressing is applied and remains in place for 24-48 hours to support healing.
Recovery Process: Most patients can return to normal activities within 3-5 days, but strenuous exercise should be avoided for at least 2 weeks. The surgical site must be kept dry for the first 48 hours, after which patients are given specific cleaning instructions to promote proper healing.
Follow-up Care: The initial follow-up visit is scheduled 7 days after surgery for suture removal and an assessment of the wound. Additional follow-ups at 2 weeks and 3 months ensure proper healing and monitor for any signs of recurrence. During these visits, patients are also provided with guidance on scar care and ways to protect the surgical site.

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Potential Risks and Complications

Preauricular sinus surgery carries standard surgical risks including bleeding, infection, and anaesthetic complications. Specific complications may include incomplete removal leading to recurrence, keloid formation, or wound dehiscence. Rarely, patients experience temporary numbness around the surgical site or injury to surrounding structures. Infection rates remain low with proper surgical technique and post-operative care.

For Singaporeans & Singapore Permanent Residents

Medisave & Insurance Shield Plan approved

Your ENT procedure may be eligible for Medisave claims, with the claimable amount varying based on the procedure’s complexity. For additional options, including the use of your insurance or Integrated Shield Plan, reach out to our friendly clinic staff today for assistance.

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Frequently Asked Questions (FAQ)

Can the preauricular sinus return after surgery?

Recurrence occurs in approximately 5-10% of cases, usually due to incomplete removal of the sinus tract. However, using proper surgical techniques and ensuring complete excision of the entire tract significantly reduces this risk.

Will the surgery leave a visible scar?

A small scar will remain after surgery, but it usually fades significantly within 6-12 months. Surgeons strategically place incisions along natural skin creases to minimise visibility.

How long does the entire procedure take?

The surgery typically lasts 45-90 minutes, depending on the complexity of the sinus tract and whether the patient has had previous surgeries. Additional time in the recovery room, generally 1-2 hours, is needed to ensure patients are stable and comfortable before discharge.

Dr Gan Eng Cern

Ear, nose and throat specialist

MBBS

MRCS (Edin)

mmed (orl)

FAMS

With over 15 years of experience, Dr Gan specialises in the comprehensive management of a broad range of conditions related to the ear, nose and throat (ENT), and head and neck.

Dr. Gan has contributed to the academic field as a Senior Clinical Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He is recognised for his extensive research work, with numerous contributions to reputable international ENT journals. Dr Gan is also highly sought after as a speaker and has shared his surgical knowledge as a surgical dissection teacher at various prominent ENT conferences and courses.

2020 – Reader’s Choice Gold Award for Best ENT Specialist (Expat Living Singapore)
2016 – Best Educator Award (Eastern Health Alliance)
2016 – “Wow” Award (Patient Compliment)

2014 – Eastern Health Alliance Caring Award – Silver
2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College of Surgeons, Academy of Medicine Singapore for best scientific surgical paper)
2012 – Human Manpower Development Award (Ministry of Health, Singapore)
2007 – Singhealth Best Doctor Award

Qualifications

MBBS – Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
MRCS (Edin) – Member of the Royal College of Surgeons Edinburgh, United Kingdom
MMed (ORL) – Master of Medicine in ENT (National University of Singapore)
FAMS – Fellow of the Academy of Medicine Singapore

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Our Location

A Specialist Clinic for Sinus, Snoring & ENT

38 Irrawaddy Road #08-45
Mount Elizabeth Novena Hospital
Singapore 329563

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