Question EXCISION OF LEFT PRE-AURICULAR CYST

amanda19791

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Fountain Inn, SC
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Small (6-8mm) fibrotic mass in the subcutaneous tissues with possible cartilage.

Indication: 14-year-old girl who has a cystic mass of the left pre-auricular space that occasionally enlarges. It is consistent with a first branchial cleft remnant.

Procedure:  The patient was placed in the supine position.  Adequate anesthesia was initiated.  Antibiotics were administered.  The head was turned to the right.  The left external auditory canal was examined and there was no opening noted.  Cotton was placed in the ear canal and the left face was prepped and draped in a sterile fashion.  A vertically-oriented elliptical incision was made to incorporate the entire subcutaneous mass.  The mass was dissected out, taking care to identify and tract running posteriorly or deep and none was found.  The mass was undermined and passed off the field to be sent to Pathology.  Hemostasis was assured.  The wound was infiltrated with Marcaine.  The skin was closed with interrupted subcuticular 5-0 Monocryl sutures and Dermabond.  The procedure was well tolerated and there were no apparent complications.

I was thinking of using 11441... can anyone take another look at?
 

thomas7331

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This sounds to me like 42810. You might want to wait for pathology to confirm that this was in fact a branchial cleft remnant.
 

elsaee87

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I think you are on the right track to use the 1144X series and if its a layered closure, the 1205X series. Pre-auricular cysts or sinuses are not the same thing as branchial cleft cysts. Those cysts are typically excisions from the NECK. I know that the ENT/Allergy specialty books also say that you can use 42810 also for pre-auricular cysts, but that doesn't make any sense since those are specifically for branchial cleft cysts, and would be utilizing a POST-Auricular incision/upper neck.
 
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