Congenital preauricular sinuses must not be considered trivial lesions. They can and should be differentiated from branchial cleft cysts. Cure is achieved only through complete excision of the sinus tract and its associated cysts. Total extirpation of the sinus tract is difficult in the presence of infection. The embryoanatomy and treatment of congenital preauricular sinus tracts as well as our experience with 6 patients are reported. We recommend excision of asymptomatic congenital preauricular sinus tracts.