Preliminary study on classification and treatment of type I variant preauricular fistula

Objective

To classify and manage Type I Variant Preauricular Fistulas (Type I VPFs) based on clinical manifestations, evaluate the efficacy of individualized surgical approaches, and provide a reference for their treatment.

Methods

From January 2016 to December 2023, our department treated 34 cases of Type I VPFs, including 19 males and 15 females, aged 11 months to 12 years (mean age: 5 years and 5 months). Sixteen cases involved the left ear, and 18 involved the right ear, with 4 cases presenting double fistulas. All cases had recurrent infections, and 7 cases had a history of incision and drainage. Based on clinical features, the fistulas were classified into Simple Type I VPFs, Conchal Type I VPFs, Retroauricular Groove Type I VPFs, External Auditory Canal Type I VPFs, and Hybrid Type I VPFs. Surgical management included complete fistula excision with adjacent crus helicis cartilage removal. Auxiliary incisions were made to debride granulation tissue based on its location, and primary flap reconstruction was performed for skin defects.

Results

The distribution of cases was as follows: Simple Type I VPFs (20.59 %, 7/34), Conchal Type I VPFs (35.29 %, 12/34), Retroauricular Groove Type I VPFs (29.41 %, 10/34), External Auditory Canal Type I VPFs (11.76 %, 4/34), and Hybrid Type I VPFs (2.94 %, 1/34). Approximately 29.41 % (10/34) of patients required flap reconstruction for defect repair, with these cases exclusively involving the conchal typeI VPFs.

Conclusion

Classification of Type I VPFs facilitates tailored surgical planning, achieving optimal functional and cosmetic outcomes.