70 Fistula/Sinus in Children Sinus tracts and fistulas in the pediatric face and neck are almost always congenital in origin, as opposed to adult patients in which they are usually related to infection, cancer, or trauma/iatrogenic. Sinus tracts and fistula are best diagnosed by their region of presentation and their location within the region. A sinus near the anterior root of the helix is a preauricular pit or sinus (Fig. 70.1). A sinus near the earlobe is usually a first branchial cleft sinus. Sinuses on the face are usually from a dermoid cyst, which will typically have a tiny hair protruding from the sinus, or an epidermal inclusion cyst
Ear
Face
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