Auricular hematoma: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Gross deformity/swelling to pinna after recent blunt trauma | *Gross deformity/swelling to pinna after recent blunt trauma | ||
*Loss of typical auricular landmarks/anatomy<ref name="Giles">Giles WC, Iverson KC, King JD, Hill FC, Woody EA, Bouknight AL. Incision and drainage followed by mattress suture repair of auricular hematoma. Laryngoscope. 2007 Dec;117(12):2097-9.</ref> | |||
*Pain out of proportion<ref name="Giles" /> | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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#Evacuate the clot | #Evacuate the clot | ||
#*Use large-bore needle/syringe to aspirate hematoma<ref name="Vuyk" /> '''AND/OR''' | #*Use large-bore needle/syringe to aspirate hematoma<ref name="Vuyk" /> '''AND/OR''' | ||
#**Needle aspiration generally is not sufficient tx<ref name="Giles" />, especially for larger hematomas | |||
#*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 | ||
#**Make incisions along natural auricular crease for cosmesis | #**Make incisions along natural auricular crease for cosmesis | ||
Revision as of 01:47, 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
- Gross deformity/swelling to pinna after recent blunt trauma
- Loss of typical auricular landmarks/anatomy[3]
- Pain out of proportion[3]
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
- Needle aspiration generally is not sufficient tx[3], especially for larger hematomas
- 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
- Use large-bore needle/syringe to aspirate hematoma[2] AND/OR
- 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
- Generally only moderately successful, and subject to poor compliance (especially with athletes[1])
- Suture
- Use fast-absorbing sutures
- Place running or interrupted sutures through cartilage and both anterior and posterior skin of auricle in mattress fashion[2]
- This should reappose the perichondrium
- Consider leaving incision open (with wound edges approximated by mattress sutures) to allow for continued drainage[1]
- Compression dressing
- Antibiotics
- Only indicated for immunocompromised patients
- Cover pseudomonas and S. aureus
Disposition
- Discharge
See Also
References
- ↑ 1.0 1.1 1.2 1.3 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 2.2 Vuyk HD, Bakkers EJ. Absorbable mattress sutures in the management of auricular hematoma. Laryngoscope. 1991 Oct;101(10):1124-6.
- ↑ 3.0 3.1 3.2 Giles WC, Iverson KC, King JD, Hill FC, Woody EA, Bouknight AL. Incision and drainage followed by mattress suture repair of auricular hematoma. Laryngoscope. 2007 Dec;117(12):2097-9.