International Journal of Case Reports and Images - IJCRI - Case Reports, Case Series, Case in Images, Clinical Images

   
Case Report
 
Preauricular pilonidal sinus: The first reported case
Abdulwahid M. Salih1, Fahmi H. Kakamad2
1Faculty of Medical Sciences, School of Medicine/Department Surgery/ University of Sulaimani/ François Mitterrand Street/Sulaymaniyah/IRAQ.
2Faculty of Medical Sciences, School of Medicine/Department Cardiothoracic and Vascular Surgery/ University of Sulaimani/ François Mitterrand Street/Sulaymaniyah/IRAQ. .

Article ID: Z01201603CR10613AS
doi:10.5348/ijcri-201626-CR-10613

Address correspondence to:
Fahmi Hussein Kakamad
Faculty of Medical Sciences
School of Medicine/Department Surgery
University of Sulaimani/ François Mitterrand Street
Sulaymaniyah/IRAQ

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Salih AM, Kakamad FH. Preauricular pilonidal sinus: The first reported case. Int J Case Rep Images 2016;7(3):162–164.


Abstract
Introduction: Pilonidal sinus is a chronic inflammatory condition associated with the penetration of hair fragments into the skin. The incidence of pilonidal sinus is 0.07%. We present the first reported case of pilonidal sinus occurring in preauricular area in a 22-year-old male.
Case Report: A 22-year-old male presented with pain and pus discharge from the right preauricular area since two years. On local examination, a scar measuring 2 cm at right preauricular area was found with one external opening. Routine investigations were within normal limits. Complete excision of the scar with the tract was performed. Primary closure of the wound was done. Histopathological examination confirmed pilonidal sinus.
Conclusion: Pilonidal disease is a complex condition that causes both discomfort and embarrassment to sufferers. The etiological origin of a pilonidal sinus is controversial. Although reported in several rare areas of the body other than sacrococcygeal area, to our knowledge, this is the first reported case in which pilonidal sinus occurs in preauricular area. Although pilonidal sinus is most frequently found in the sacrococcygeal region, it could occur in other area including preauricular area.

Keywords: Chronic discharging sinus, Hair containing, Pilonidal sinus, Preauricular sinus


Introduction

Pilonidal sinus is a chronic inflammatory condition associated with the penetration of hair fragments into the skin. It is a blind tract lined with granulation tissue, which ends in a cavity containing pus [1]. It can be a chronic and recurring condition which is sometimes difficult to cure [2]. The incidence of pilonidal sinus is 0.07% and it is higher among men aged between 15 and 30 years [2]. Male sex, young age, hairiness, deep navel and poor personal hygiene were found to be predisposing factors [3]. Pilonidal sinus occurs mainly in the sacrococcygeal area [4]. However, it may also occasionally occur in other areas like axilla, groin, interdigital web, umbilicus, nose, suprapubic area, clitoris, prepuce, penis, or occiput [5].

We present the first reported case of pilonidal sinus occurring in preauricular area in a 22-year-old male.


Case Report

A 22-year-old male presented with pain and pus discharge from the right preauricular area with intermittent fever since two years. On local examination, a scar measuring 2 cm at right preauricular area was found with one external opening on the center of the scar. Routine investigations were within normal limits. Under local anesthesia, an elliptical incision was taken, complete excision of the scar with the tract was performed. Primary closure of the incision was done. Histopathological examinations showed sinus tract in the center infiltrated by mixed inflammatory cells, associated with foreign body giant cell reaction which contains hair particles (Figure 1). The postoperative course was uneventful. Two months later, wound margin was clear.


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Figure 1: Histological appearance of pilonidal sinus (H&E stain, x100).



Discussion

Pilonidal disease is a complex condition that causes both discomfort and embarrassment to sufferers, and imposes direct costs to the healthcare system and indirect costs to society through absence from work [6]. The etiological origin of a pilonidal sinus is controversial. In the sacrococcygeal region, early reports favored a congenital origin which was unequivocally rejected by clinicians in the second half of the twentieth century [7]. Friction (abduction-adduction), suction, massage, shaving, pounding, minor infection and maceration are assorted mechanisms which play a part in acquired theory of pilonidal sinus [8].

The histological picture and the contents of the pilonidal sinus have been described in detail. All authors agree that the presence of loose hairs is essential for the diagnosis of a pilonidal sinus. Clinically, pilonidal sinus present as pain, local infection and redness [1]. The commonly adopted surgical techniques in contemporary science for management of pilonidal sinus include incision and drainage, excision and healing by secondary intention, excision and primary closure, and excision with reconstructive flap techniques [6].

Although reported in several rare areas of the body other than sacrococcygeal area, to our knowledge, this is the first reported case in which pilonidal sinus occurs in preauricular area.


Conclusion

Pilonidal sinus is most frequently found in the sacrococcygeal region, and is less commonly encountered at other sites. If a hair bearing lesion presents over the face including preauricular area, it could be pilonidal sinus. Histopathological examination is usually confirmatory.


References
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  2. Shinde P, Toshikhane H. Pilonidal sinus (Nadi vrana): A case study. Int J Ayurveda Res 2010 Jul;1(3):181–2.   [CrossRef]   [Pubmed]    Back to citation no. 2
  3. Sengul I, Sengul D, Mocan G. Axillary pilonidal sinus: A case report. N Am J Med Sci 2009 Nov;1(6):316–8.   [Pubmed]    Back to citation no. 3
  4. Søndenaa K, Andersen E, Nesvik I, Søreide JA. Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis 1995;10(1):39–42.   [CrossRef]   [Pubmed]    Back to citation no. 4
  5. Eryilmaz R, Sahin M, Okan I, Alimoglu O, Somay A. Umbilical pilonidal sinus disease: predisposing factors and treatment. World J Surg 2005 Sep;29(9):1158–60.   [CrossRef]   [Pubmed]    Back to citation no. 5
  6. Oueidat D, Rizkallah A, Dirani M, Assi TB, Shams A, Jurjus A. 25 years' experience in the management of pilonidal sinus disease. Open Journal of Gastroenterology 2014;4:1–5.   [CrossRef]    Back to citation no. 6
  7. Yavalkar P, Shelke R. Intermammary Pilonidal Sinus: A Case Report. Indian Journal of Medical Case Reports 2014;3(2):20–2.    Back to citation no. 7
  8. Chopade AB, Shojai AR, Jadhav R, Yadav V. Pilonidal sinus over a rare site. IJSR 2015;4:(2).   [CrossRef]    Back to citation no. 8

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Author Contributions
Abdulwahid M. Salih – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Fahmi H. Kakamad – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Abdulwahid M. Salih et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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