The role of medical imaging in the management of a complex prehelix fistula in children: A case report

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Introduction: Complex prehelix fistula is an extremely common congenital malformation in children, but of course it is not always diagnosed quickly. The aim of this study was to show the added value of medical imaging for handling a complex prehelix fistula in our context. Case Report: We report, here, a left prehelix fistula in an 11-year-old girl, seen and treated at the ear, nose, and throat (ENT) department for a small opening in front of the left helix with a swelling in front of the tragus for several years. We performed an incision and drainage of the pretragial abscess combined with antibiotic and anti-inflammatory therapy, followed by a prehelix fistulotomy (sinusectomy) without prior fistulography. The postoperative course was marked by a remission lasting approximately five months, after which several episodes of pre-tragus abscesses occurred in succession, all controlled by antibiotic therapy. Postoperative fistulography revealed a long, sinuous fistulous tract, explaining the recurrence. Magnetic resonance imaging performed one year later revealed associated brain malformations and the absence of an active fistula tract, indicating healing of the fistula without the need for reintervention. Conclusion: The prehelix fistula is associated with a high rate of recurrence and infectious episodes. Medical imaging plays a key role in the pre- and postoperative management of the prehelix fistula. This clinical case demonstrates the value of medical imaging both for preoperative mapping and for identifying associated malformations.

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