Pre- and post-auricular sinus

A 16-year-old female patient presented with left preauricular sinus since birth with retro auricular swelling and discharge since 2 years. Examination revealed two puncta: one anterior to the tragal line and one posterior to it. She had a history of previous surgery at another institution. Our case had two puncta both anterior and posterior to the tragal line and the tract which was extending from anterior to the external auditory canal extending superior to it till the postauricular groove: features which are common to preauricular and postauricular sinuses. We present our use of the bi-directional approach to complete excision and discuss the anatomical basis of this approach.