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A 2yo child presents with a 1.5cm diameter erythematous tender fluctuant swelling in the right preauricular area. There is a small pinhole sized indentation in the center. Which of the following is not appropriate management?
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April 28, 2020 at 12:46 pm
A) Incision and drainage of the abscess
Preauricular pits, cysts, and sinuses are relatively common congenital outer ear malformations. They may be isolated or associated with certain syndromes or with renal anomalies. They may remain asymptomatic, or may become infected or cysts may slowly grow in size over time. When infected, conservative management with warm compresses and anti-staphylococcal and anti-streptococcal antibiotics should be instituted, along with referral to an otolaryngologist. Standard incision and drainage as done for other skin abscesses should be avoided, both because of cosmetic concerns and because complete surgical excision of the cyst or sinus is needed for cure. However, either probing the preauricular pit opening or performing needle aspiration can be done to encourage drainage and hasten resolution of infection.