"Preauricular Cyst"

Waiting to see Dr. Brand, his pediatric surgeon. He was in a good mood here, laughing with Daddy, kicking his legs, playing with the paper and ripping it up. His smile soon faded and the laugh quickly turned into a cry when Doc came into the room and began investigating the ear.

As of yesterday, we now have a scientific diagnosis and description for Kayden's once unknown condition, defined as an "abnormal gate". It has been concluded that the only way to correct it is to have it surgically removed. I somewhat understood what the surgeon was trying to convey to me in the explanation but to save myself some time in trying to word it correctly as well as include details, I'll have eMedicine.com describe it to all instead. For those medically illiterate, like myself, I defined the larger, unknown medical termenology to help with understanding it more clearly, thanks to Wikipedia.

Kayden was very giddy up until the doctor entered the room. Then once Doc got closer to him, started investigating the ear, and using his stethoscope, Kayden started to cry. Poor guy, I'm so sad he has to go through this. At the same time, I'm very grateful this is the extent of the malformations that took place during my pregnancy with him! It could have been A LOT worse. I know he will be okay but I have two fears, and call me pessimistic, but it is reality and does happen! One that he won't wake up from being put to sleep and second, that he isn't all the way under and he still feels the pain but is unresponsive. I saw a medical show on that one time--a lady was going into surgery and she was unresponsive and looked like she was asleep but she was awake the whole time and could feel AND smell EVERYthing that was happening to her. Thank goodness he's young and won't remember any of this!

I will keep everyone updated on when his surgery is, and other details as they come along. Just in the meantime, keep him in your prayers! He finished his second round of antibiotics and the infection has not gone away. I hope the situation doesn't worsen before we can have it take care of.

Definition
"Preauricular cysts, pits, fissures, and sinuses are benign congenital malformations of the preauricular (ear) soft tissues first described by Van Heusinger in 1864. Preauricular pits or fissures are located near the front of the ear and mark the entrance to a sinus tract that may travel under the skin near the ear cartilage. These tracts are lined with squamous epithelium and may sequester to produce epithelial-lined subcutaneous cysts or may become infected, leading to cellulitis or abscess .

Description
Preauricular tags are epithelial mounds or pedunculated skin that arise near the front of the ear around the tragus. They have no bony, cartilaginous, or cystic components and do not communicate to the ear canal or middle ear. Patients identified with preauricular pits or cysts should be examined for other congenital anomalies.

Frequency
Malformations of the external ear are not uncommon. Generally, they occur in 1 of every 12,500 births. Incidence of spontaneous formation of ear pits in the nonsyndromic population ranges from 0.3-0.9%. These conditions affect males and females equally and have no race predilection.

Etiology
Embryology and branchial arch development--The auricle forms during the sixth week of gestation. The first and second branchial arches give rise to a series of 6 mesenchymal proliferations known as the hillocks of His, which fuse to form the definitive auricle. The first arch gives rise to the first 3 hillocks, which form the tragus, helical crus, and the helix. The second arch gives rise to the second 3 hillocks, which form the antihelix, scapha, and the lobule.
Defective or incomplete hillock fusion during auricular development is postulated as the source of the preauricular sinus. Another theory suggests that localized folding of ectoderm during auricular development is the cause of preauricular sinus formation. The first 3 hillocks are most often linked to supernumerary hillocks, leading to preauricular tag formation.

Genetics
Correct sequential gene activation is required for normal ear and facial development. Interrupting the gene activation sequence in laboratory animals disrupts ear development.
Genetic linkage analysis studies have suggested that congenital preauricular sinus localizes to chromosome 8q11.1-q13.3. The inner neurological hearing apparatus, cochlea, and auditory nerve form in conjunction with the outer ear structures during the early developmental stages. External deformities may be associated with an inner neurological deformity and, hence, suggest a possible deafness." (Interestingly enough, one of Jon's sisters had the same condition except in a different location)

Video 1 of Kayden having a good time with Daddy just before Doc came in the room--that was the knock on the door. There is a second video of the kids that I'll post after while.