Auricular hematoma: Difference between revisions
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==Management== | ==Management== | ||
*Indications for drainage<ref>Laybell I et al. Auricular Hematoma Drainage. Aug 7, 2015. http://emedicine.medscape.com/article/82793-overview#a8</ref> | |||
**Traumatic swelling that deforms pinna | |||
**Within 7 days of trauma | |||
*Contraindications - in these cases, refer to ENT due to formation of granulation tissue that may require debridement | |||
**Recurrent or chronic hematomas | |||
**> 7 days from trauma | |||
#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''' | ||
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#**Remove hematoma by gentle suction or curettage | #**Remove hematoma by gentle suction or curettage | ||
#Prevent re-accumulation of hematoma (goal is to close the dead space between perichondrium and cartilage<ref name="Roy" />). Multiple methods available: | #Prevent re-accumulation of hematoma (goal is to close the dead space between perichondrium and cartilage<ref name="Roy" />). Multiple methods available: | ||
#*Compression dressing | #*Compression dressing rather than simple dressing | ||
#**Pack the helix w/ petroleum jelly-impregnated gauze | #**Pack the helix w/ petroleum jelly-impregnated gauze | ||
#**Place regular gauze both in front of and behind the ear | #**Place regular gauze both in front of and behind the ear | ||
Revision as of 23:40, 10 February 2016
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
- Indications for drainage[4]
- Traumatic swelling that deforms pinna
- Within 7 days of trauma
- Contraindications - in these cases, refer to ENT due to formation of granulation tissue that may require debridement
- Recurrent or chronic hematomas
- > 7 days from trauma
- 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 rather than simple 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 rather than simple 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.
- ↑ Laybell I et al. Auricular Hematoma Drainage. Aug 7, 2015. http://emedicine.medscape.com/article/82793-overview#a8