Auricular hematoma: Difference between revisions
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== Background == | ==Background== | ||
* | *Caused by blunt trauma to external ear | ||
*Separation of perichondrium from underlying cartilage tears the adjoining blood vessels | **Associated with contact sports such as boxing, wrestling, etc. | ||
** | *Separation of perichondrium from underlying cartilage tears the adjoining blood vessels<ref name="Roy">Roy S, Smith LP. A novel technique for treating auricular hematomas in mixed martial artists (ultimate fighters). Am J Otolaryngol. 2010 Jan-Feb;31(1):21-4.</ref> | ||
**Usually occurs on anterior surface, since skin is firmly adherent to cartilage (on posterior ear, there is underlying muscle and adipose is it loosely adherent to cartilage)<ref name="Vuyk">Vuyk HD, Bakkers EJ. Absorbable mattress sutures in the management of auricular hematoma. Laryngoscope. 1991 Oct;101(10):1124-6.</ref> | |||
**Recurrent hematomas lead to infection and/or cartilage necrosis and neocartilage formation (i.e. "cauliflower ear") | |||
**Goal of treatment is to prevent "cauliflower ear" deformity | |||
[[File:Cauliflower ear by dr vikram yadav.jpg|thumb|Auricular hematoma]] | |||
==Clinical Features== | ==Clinical Features== | ||
* | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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{{Maxillofacial trauma DDX}} | {{Maxillofacial trauma DDX}} | ||
== | ==Diagnostic Evaluation== | ||
*Clinical diagnosis | *Clinical diagnosis | ||
== | ==Management== | ||
#Evacuate the clot | #Evacuate the clot | ||
#*Use large-bore needle/syringe to aspirate hematoma<ref name="Vuyk" /> '''AND/OR''' | |||
#*Make semi-circle incision inside the inner curvature of the helix or antihelix | #*Make semi-circle incision inside the inner curvature of the helix or antihelix | ||
#*Remove hematoma by gentle suction or curettage | #**Make incisions along natural auricular crease for cosmesis | ||
#Prevent re- | #**Remove hematoma by gentle suction or curettage | ||
#*Pack the helix w/ petroleum jelly-impregnated gauze | #Prevent re-accumulation of hematoma (goal is to close the dead space between perichondrium and cartilage<ref name="Roy" />). Multiple methods available: | ||
#*Place regular gauze both in front of and behind the ear | #*Compression dressing | ||
#*Circle the head with a compressive wrap | #**Pack the helix w/ petroleum jelly-impregnated gauze | ||
#**Place regular gauze both in front of and behind the ear | |||
#**Circle the head with a compressive wrap | |||
#*Suture | |||
#**Place | |||
#Antibiotics | #Antibiotics | ||
#*Only indicated for immunocompromised patients | #*Only indicated for immunocompromised patients | ||
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*[[Maxillofacial Trauma]] | *[[Maxillofacial Trauma]] | ||
== References == | ==References== | ||
<references/> | |||
[[Category:ENT]] | [[Category:ENT]] | ||
Revision as of 01:08, 10 September 2015
Background
- Caused by blunt trauma to external ear
- Associated with contact sports such as boxing, wrestling, etc.
- Separation of perichondrium from underlying cartilage tears the adjoining blood vessels[1]
- Usually occurs on anterior surface, since skin is firmly adherent to cartilage (on posterior ear, there is underlying muscle and adipose is it loosely adherent to cartilage)[2]
- Recurrent hematomas lead to infection and/or cartilage necrosis and neocartilage formation (i.e. "cauliflower ear")
- Goal of treatment is to prevent "cauliflower ear" deformity
Clinical Features
Differential Diagnosis
Ear Diagnoses
External
- Auricular hematoma
- Auricular perichondritis
- Cholesteatoma
- Contact dermatitis
- Ear foreign body
- Herpes zoster oticus (Ramsay Hunt syndrome)
- Malignant otitis externa
- Otitis externa
- Otomycosis
- Tympanic membrane rupture
Internal
- Acute otitis media
- Chronic otitis media
- Mastoiditis
Inner/vestibular
Maxillofacial Trauma
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Diagnostic Evaluation
- Clinical diagnosis
Management
- Evacuate the clot
- Use large-bore needle/syringe to aspirate hematoma[2] AND/OR
- Make semi-circle incision inside the inner curvature of the helix or antihelix
- Make incisions along natural auricular crease for cosmesis
- Remove hematoma by gentle suction or curettage
- Prevent re-accumulation of hematoma (goal is to close the dead space between perichondrium and cartilage[1]). Multiple methods available:
- Compression dressing
- Pack the helix w/ petroleum jelly-impregnated gauze
- Place regular gauze both in front of and behind the ear
- Circle the head with a compressive wrap
- Suture
- Place
- Compression dressing
- Antibiotics
- Only indicated for immunocompromised patients
- Cover pseudomonas and S. aureus
Disposition
- Discharge
See Also
References
- ↑ 1.0 1.1 Roy S, Smith LP. A novel technique for treating auricular hematomas in mixed martial artists (ultimate fighters). Am J Otolaryngol. 2010 Jan-Feb;31(1):21-4.
- ↑ 2.0 2.1 Vuyk HD, Bakkers EJ. Absorbable mattress sutures in the management of auricular hematoma. Laryngoscope. 1991 Oct;101(10):1124-6.