The removal of an epidermal cyst from the ear requires precision to ensure complete excision while minimizing the risk of recurrence and scarring. Here’s the best approach:

1. Preoperative Considerations

• Assessment: Confirm the diagnosis through clinical examination. If needed, use ultrasound to assess the cyst depth.
• Patient Preparation: Advise the patient on the procedure, risks, and post-operative care.
• Sterilization: Clean the area with an antiseptic solution (chlorhexidine or povidone-iodine).

2. Surgical Removal

• Anesthesia: Local anesthesia (lidocaine with epinephrine) to minimize bleeding and pain.
• Incision Choice:
  • If the cyst is small and intact, a minimal excision technique using a small incision over the cyst may allow for easy removal.
  • For larger cysts, an elliptical incision around the cyst with an undermining approach is recommended.
• Complete Excision: The entire cyst, including its capsule, must be removed to prevent recurrence. Avoid rupture of the cyst to minimize inflammation.
• Hemostasis: Cauterization or pressure control bleeding.

3. Closure and Scar Prevention

• Minimal Suturing: Use fine sutures (e.g., 6-0 or 7-0 non-absorbable) to reduce scarring.
• Wound Edges Approximation: Avoid excessive tension to prevent hypertrophic scarring.
• Topical Scar Prevention: Consider silicone gel or sheets post-healing.

4. Postoperative Care

• Antibiotics (if needed): If infection risk is high, a short course of antibiotics may be prescribed.
• Wound Care: Keep the area clean and dry; apply antibiotic ointment.
• Follow-up: Monitor for signs of infection or recurrence.

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