Auricular hematoma

(Redirected from Auricular Hematoma)

Background

Ear anatomy
  • 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 by draining the hematoma in a timely fashion

Clinical Features

Auricular hematoma
  • Gross deformity/swelling to pinna after recent blunt trauma
  • Loss of typical auricular landmarks/anatomy[3]
  • Pain out of proportion[3]
  • Hematoma most commonly collects in the scaphoid fossa and the concha

Differential Diagnosis

Ear Diagnoses

External

Internal

Inner/vestibular

Maxillofacial Trauma

Evaluation

A small auricular hematoma after drainage.
  • 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

Procedure

  1. Perform an auricular block
  2. Evacuate the clot
    • Option 1: Make semi-circle incision inside the inner curvature of the helix or antihelix
      • Make incisions along natural auricular crease for cosmesis
      • Remove hematoma by milking of the hematoma toward the incision. Suction or curettage may also be helpful
      • Use a butterfly hemostat or suture kit needle driver to break up any hematoma that is not easily coming out
    • Option 2: Use large-bore needle/syringe to aspirate hematoma[2]
      • Needle aspiration generally is not sufficient treatment[3], especially for larger hematomas as clot has usually already formed and cannot be aspirated
  3. Prevent re-accumulation of hematoma (goal is to close the dead space between perichondrium and cartilage[1]). Multiple methods available:
    • Option 1: Compression dressing
      • Pack the helix with 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])
      • Alternative to petroleum jelly gauze is to splint the ear with a molded piece of plaster [5] [6]which fits better and does not need as tight of a compression dressing.
    • Option 2: 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]
    • Option 3: Bolster sutured in place- combination of the above two methods
      • Use non-absorbable 2-0 or 3-0 nylon
      • Pack the helix with petroleum jelly impregnated gauze. Place a thick layer of gauze behind the ear
      • Perform a running quilt stitch through the anterior gauze, through the pinna, and through the posterior gauze
  4. Antibiotics
    • Often used by our ENT colleagues in all patients though it is actually only recommended for immunocompromised patients
    • Cover pseudomonas and S. aureus- Cipro is the most commonly used

Disposition

  • Discharge
  • ENT followup in 2-3 days for suture removal or dressing removal and wound check

Complications

"Cauliflower" ear.
"Cauliflower" ear.
  • Failure to fully drain and maintain drainage of an auricular hematoma can result in "Cauliflower ear," a permament cosmetic defect.

Prevention

Wrestling protective headgear.
Rugby protective headgear.
  • Auricular hematoma can be prevented by use of appropriate headgear in sports prone to repeat ear trauma (e.g., wrestling, rugby, MMA).

See Also

External Links

References

  1. 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. 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. 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.
  4. Laybell I et al. Auricular Hematoma Drainage. Aug 7, 2015. http://emedicine.medscape.com/article/82793-overview#a8
  5. Trick of the Trade: Splinting the ear from AliEM https://www.aliem.com/trick-of-trade-splinting-ear/
  6. Ear Lacerations, Part II from Lacerationrepair.com https://lacerationrepair.com/techniques/anatomic-regions/ear-lacerations-part-ii/