Pseudocyst of pinna: a recurrence-free approach

"Revolutionizing auricular seroma treatment: exploring diverse surgical strategies with a comprehensive case study"

Auricular seromas present a significant therapeutic challenge due to their propensity for recurrence and potential for cosmetic deformity. This case series illustrates the effective management of post-traumatic auricular seromas through diverse surgical approaches in two patients. Each case highlights the use of different splinting materials post-surgery, detailing the clinical presentations, surgical interventions, and follow-up outcomes. Additionally, the study reviews alternative treatment modalities reported in the literature, providing a comprehensive overview of current strategies for managing auricular seromas. By exploring these cases, the study enhances understanding of the surgical strategies and their outcomes, emphasizing the importance of tailored treatments for auricular seromas.

A Systematic Review of Treatment Protocols in Auricular Pseudocysts

A systematic review of literature on treatment modalities available with respect to efficacy, complications and recurrences so as to guide the clinician to better treat this enigmatic condition. A systematic search of PubMed, Google Scholar, Ovid and Cochrane databases. Articles in English that described or compared treatment were included. Articles without clear treatment end-points or follow-up data were excluded. Patients were then divided by primary treatment modality into Aspiration, Incision & Drainage (I&D), surgical deroofing, intralesional steroids (ILS) and No treatment groups and compared with respect to cure rates, complications and residual thickening using Chi-square test. Similarly confounding variables compression and suturing were compared. 85 articles were selected and reviewed (1699 patients; mean follow-up 7.8 months). Surgical deroofing had the highest cure rate (98.2%) followed by I&D (95.4%), both of which were significantly more efficacious than Aspiration with or without ILS (p < 0.001). Aspiration with ILS had the highest rate of complications (13.6%) and residual thickening (16.7%); significantly more than other treatment modalities. Aspiration with negative pressure device had a 100% cure in the few reported articles (n = 57). Compression had no significant advantage overall, but suturing significantly increased cure rates. Surgical deroofing and I&D are the most efficacious treatments. Aspiration + ILS has lower cure and significantly increased complications, hence should be avoided. Based on the results, we propose a treatment protocol for auricular pseudocyst. As only two high-quality randomized controlled trials were available in literature, further research in comparing treatment is warranted.

Our Experience at Tertiary Medical College: Comparative Study Between Surgical Deroofing with Buttoning Technique and Posterior Cartilage Window with Pressure Gauze Dressing Technique in Patients with Pseudocyst of Pinna

A pseudocyst of pinna is benign, painless, rare and asymptomatic swelling on the lateral or anterior surface of the pinna resulting from intracartilaginous accumulation of fluid. The condition auricular pseudocyst was first described by Engel (Arch Otolaryngol 83:197-202, 1966). Pseudocyst of in majority of cases presents as unilateral lesions, predominantly in 35-40 years mean age group and affecting predominantly males (Ramadass and Ayyaswamy in Indian J Otolaryngol Head Neck Surg 58:156-192, 2006). Commonly these cysts shows no symptoms but occasionally, there may be presence of minor discomfort and mild inflammatory signs. The pseudocyst of pinna typically involves in its descending order of involvement as scaphoid fossa, triangular fossa of the antihelix, and the Cymba concha (Ramadass and Ayyaswamy in Indian J Otolaryngol Head Neck Surg 58:156-192, 2006). Diagnosis of psuedocyst is based mainly on the clinical characteristics without evidence of infection (Ramadass and Ayyaswamy in Indian J Otolaryngol Head Neck Surg 58:156-192, 2006). There are wide range of treatment modalities described in the literature for this condition ranging from medical line of management including minimally invasive Intralesional steroid therapy, intralesional sclerosant therapy, systemic steroid therapy to surgical line of management including aspiration and pressure dressing, quilting suture with corrugated rubber drain, incision and drainage with mastoid dressing, cartilage curettage with drainage tube, surgical de-roofing and cartilage window procedure. Although multiple treatment options are available for this condition,there is no gold standard option is found In literature as more invasiveness of procedure associated with more complications and less invasiveness is associated with more recurrence (Bhat et al. in J Clin Diagn Res 8:KC05-KC07, 2014). The main aim of treatment is preservation or restoration of normal Anatomy or architecture of the auricle without recurrence or complications in postoperative duration (Schulte et al. in J Am Acad Dermatol 44:285-286, 2001). In our study we are going to compare the surgical deroofing with buttoning technique with Posterior Cartilage window with Pressure Gauze dressing technique in patients with pseudocyst on the basis of recurrence and complications. To compare effectiveness in terms of recurrence and complications between surgical deroofing with buttoning technique and posterior cartilage window with Pressure Gauze dressing technique in patients with pseudocyst of pinna. Prospective observational study done for duration of one year from June 2021 till June 2022 at Ashwini Rural medical college and Hospital, Solapur. Study was done on 30 patients aged between 20 and 70 years with pseudocyst of who are diagnosed on the basis of clinical presentation and characteristics of the aspirated fluids with no signs of infection or inflammation. Among 30 patients with pseudocyst 15 patients were undergone surgical deroofing with buttoning technique and remaining 15 patients were undergone posterior cartilage window with Pressure Gauze dressing technique. The age distribution of patients with psuedocyst of pinna in our study ranged from 20 to 70 years with maximum number of cases (i.e. 16) in the age group of 30-40 years which comprised of about 53% of study population. Among 30 cases in our study 26 were males (86.7%). All cases were of unilateral pseudocyst with left ear involvement more than right ear i.e. 20 and 10 cases respectively which indicates predominantly affecting left ear (66.6%). In our study we observed the site of involvement of pinna by pseudocyst showing maximum number of cases involving combined scaphoid fossa and triangular fossa i.e. 15 cases (50%) and minimum number of cases involving Concha i.e. 2 cases (6.6%). In our study we found that the aspirated fluid from pseudocyst of pinna was sterile in all cases i.e. 30 cases (100%). In our study we observed that the aspirated fluid was serous in majority of cases i.e. 21 cases (70%) and serosanguinous in few of them i.e. 3 cases (10%). Success rate in our study for surgical deroofing with buttoning technique was 66.6% and for posterior cartilage window with Pressure Gauze dressing technique was 100% but in terms recurrence of pseudocyst of pinna, 2 groups were not statistically significant. Success rate in our study for posterior cartilage window with Pressure Gauze dressing technique was 100% with no recurrence. Among patients who have undergone surgical deroofing with buttoning technique 2 cases have minor complications like pressure discoloration of skin i.e. 1 case and thickening of skin of pinna i.e. 1 case. All these complications are temporary one and show recovery in follow up duration. Among patients who have undergone Posterior cartilage window with Pressure Gauze dressing technique 1 case had perichondritis at 1 week follow up which was resolved spontaneously at the end of 2 weeks and 2 cases had painless thicknening of pinna which also resolved spontaneously at the end of 2 weeks. Pseudocyst of pinna occurs commonly in middle aged males as unilateral lesions with left ear involvement in majority of cases. The most common involvement of pinna by pseudocyst is combined scaphoid fossa and triangular fossa, the least common site is concha. Most of the pseudocyst of pinna contain sterile serous fluid. Success rate in our study for surgical deroofing with buttoning technique was 66.6% and for posterior cartilage window with Pressure Gauze dressing technique was 100% but in terms recurrence 2 groups were not statistically significant. Both surgical treatment groups have few and temporary complications but in terms of complications 2 groups were not statistically significant.

Application Effect of Modified Through and Through Suture in Anterior Chondrectomy of Auricular Pseudocyst

Objective

To introduce a novel method of modified through and through suture with collagen sutures in conjunction with anterior chondrectomy of auricular pseudocyst and assess its therapeutic efficacy.

Subjects and Methods

The study comprised 87 patients with unilateral auricular pseudocyst, treated in our department from December 2019 to November 2021. Following anterior chondrectomy of the cyst, modified through and through suture was performed using collagen sutures. Evaluation of successful resolution of the problem, assessment of complications, recurrence, and ultimate ear cosmesis was undertaken with a minimum of 6 months follow-up.

Results

There were 83 males and 4 females, ages ranged from 26-78 years old, with a median age of 41 years. The right and left ears were affected in, 52 and 35 patients, respectively. Local skin color deepening was found in 15 patients within 3 months, which returned to normal within 5 months. During the follow-up, such complications as anaphylaxis, hematocele in the surgical cavity, incision infection, and deformity were not observed in any patients. All patients were cured with a single operation without relapse.

Conclusion

The modified through and through suture with collagen sutures in conjunction with anterior chondrectomy of an auricular pseudocyst is characterized by a straightforward, single-stage operation, with no relapses, few complications, restoration of normal ear cosmesis, and high patient acceptance.

Seroma of Auricle

The pseudocyst of the auricle is an intracartilaginous lesion defined as the accumulation of sterile, straw-coloured fluid in a cyst unlined by epithelium. It is more common in males. The most common site of lesion is the scaphoid fossa and right ear. Though the aetiology remains unclear, it may be associated with mechanical irritation, repeated minor injuries and chronic trauma. If left untreated, it can lead to permanent deformity of the auricle. Pseudocyst of the auricle is a rare and challenging condition. Medical management has unfortunately shown no practical results. Hence, surgical treatment modalities are the best option. The universal aim of treatment is the conservation and restoration of the anatomical structure of the pinna, removal of cystic lesions and prevention of recurrence. Simple aspiration or incision and drainage alone lead to reaccumulation of cystic fluid in most cases. The technique of incision and drainage is the easiest but has a high recurrence rate. Conservative treatment often results in recurrence and unsatisfactory results. Other treatment modalities include incision and drainage with daily irrigation, auricular splinting, aspiration with intralesional steroid injection, aspiration followed by compression dressing, or aspiration with intralesional steroid injection followed by compression dressing and surgical deroofing, surgical deroofing followed by compression with buttons or sheet or sandwich method. Cysts with a diameter less than 1 cm are dealt with through non-surgical treatment modalities, while for cysts having a diameter greater than 1 cm, surgery is considered as first choice therapy. These treatment options have shown promising results. Various modifications in the traditional techniques have reduced the recurrence rate, successfully treated the condition and shown good cosmetic results. This review article aims at providing a holistic collection of various conventional treatment modalities and novel modifications introduced, which can be used in a sequence of definitive treatments of seroma of the auricle.

Auricular pseudocysts: a systematic review of the literature

BACKGROUND

Auricular pseudocysts are benign fluid accumulations of the ear of uncertain etiology. Little is known about the optimal modality to successfully treat these lesions. No systematic review addressing auricular pseudocysts have been published to date.

OBJECTIVES

The aim of this study is to summarize all the published data regarding diagnostic and therapeutic challenges of auricular pseudocysts.

METHODS

On May 28, 2020, a systematic search of Medline, Embase, and Cochrane databases was conducted. All the studies describing treatment of auricular pseudocysts, procedure description, outcome, and follow-up period were included in this review.

RESULTS

After full-text article review, 74 articles were included, representing a total of 1,011 lesions. The commonly used treatments for auricular pseudocysts were deroofing (493 lesions), aspiration (284 lesions), incision and drainage (171 lesions), intralesional steroids (53 lesions), and observation (10 lesions). The highest cure rate was found with the deroofing procedure (97.2%) followed by incision and drainage (95.9%). The mean follow-up period was 6.7 months.

CONCLUSION

Surgical procedures (anterior deroofing or incision and drainage) showed the highest cure rates and should be considered as first-line treatment for auricular pseudocysts. Future adequately designed randomized controlled trials are warranted to compare the efficacy of the techniques described.

Case Series and Systematic Review of Treatment Outcomes for Auricular Pseudocysts

OBJECTIVE

Auricular pseudocyst (AP: intracartilaginous cyst, endochondral AP, cystic chondromalacia, and benign idiopathic cystic chondromalacia) is a benign condition of unknown etiology. This report systematically reviews the published demographics, treatment protocols, and outcomes of AP between the various medical disciplines, and compares the findings to a theretofore-unreported 12-patient cohort. Primary outcome measure was AP complete resolution without recurrence.

DATA SOURCE

A systematic literature search of "MEDLINE" via "PubMed" and "Google Scholar" was performed in June, 2020. The 12 new patients were enrolled between January 2016 and December 2020.

STUDY SELECTION

Seventy-four papers met the study inclusion criteria and provided data on sex distribution, surgical approach and outcome, performance of approaches according to medical specialty, and recurrence rates of the reported AP populations.

DATA EXTRACTION

The appropriateness and study design quality were independently assessed by two reviewers.

DATA SYNTHESIS

The primary outcome was therapeutic success. A comparative analysis was also performed on the same extracted information that was retrieved from the medical files of the 12 new patients (10 men, 2 women, average age 24 yrs, range, 17-38).

CONCLUSIONS

AP is not uncommon. In line with the published literature, incision and curettage with excision of the anterior pseudocystic wall (deroofing) resulted in a recurrence rate of less than 17% with good cosmetic outcome among all 12 patients. Aspiration alone was associated with increased recurrence rates. Deroofing emerged as the preferred modality, with good cosmetic outcome and reduced recurrence rate. It was usually performed by otolaryngologists, while dermatologists used more conservative approach more frequently. Incision and drainage combined with compression reduces risk of recurrence.

A novel negative pressure drainage treatment of auricular pseudocyst

OBJECTIVE

Pseudocyst of the auricle is a benign cystic lesions of the ear. A variety of methods have been proposed priorly with different treatment effects. Although aggressive treatments may have good results, we aimed to introduce a less invasive method that also yield optimal cosmetic outcome.

PATIENTS AND METHODS

From August 2019 to April 2020, a total of 32 patients with pseudocyst of the auricle were treated with a novel negative pressure drainage method.

RESULTS

The treatment has performed successfully in all patients. Only 2 patients experienced negative pressure drainage device detachment, and recovered smoothly after reinstallment. Patients were followed up for an average period of 3 months. The appearance of the auricle was recovered excellent in all patients. There were no postoperative complications or episodes of recurrence during the follow-up period.

CONCLUSION

Considering the excellent cosmetic outcome and free of recurrence, we would recommend our negative pressure drainage method as a first-line treatment for all patients with auricular pseudocyst.

Treatment of Auricular Pseudocyst with Intralesional Steroid: A Study with Short-Term Follow-Up

Introduction

A pseudocyst is an uncommon, painless, benign cystic swelling on the lateral surface of the auricle with an unknown etiology. Various treatment modalities have been used with varying rates of success as this condition has high propensity for recurrence. We have used a minimally invasive treatment method for this condition to evaluate its efficacy in our setup.

Patients and Methods

This is a prospective study carried out in the department of ENT of Chitwan Medical College from May 2018 to April 2020. Complete aspiration of the pseudocyst with intralesional steroid (40 mg, triamcinolone acetonide) injection was done in 30 patients. They were followed up weekly for 4 weeks. Additional doses were injected in cases with persistence or recurrenqce before 3 weeks. Disappearance of the swelling, considered treatment success, was the main outcome. The total number of doses required for the complete resolution of the swelling along with the number of recurrences or complications, if any, were noted at the final follow-up at 4 weeks.

Results

All of our patients responded completely with intralesional triamcinolone. However, the total dose requirement for different patients varied. Out of the 30 patients, 21 (70%) responded to the single dose of the drug. Six (20%) required a second dose, while the remaining 3 (10%) patients required a third dose for complete resolution of the swelling. All three (10%) patients who received a third dose of triamcinolone complained of skin thickening, but there was no obvious cosmetic deformity.

Conclusion

Aspiration with intralesional steroid injection shows an immediate positive response in patients with auricular pseudocyst. It can achieve complete resolution of the swelling without any serious complications. Thus, it appears to be a simple and effective management of the condition in the short term.

Comparison and evaluation of three techniques for treating auricular pseudocyst

Background: Auricular pseudocyst is a benign cystic lesion in cartilages of the auricle. Different methods are currently used to manage this disease. In these methods, simple aspiration combined with pressure dressing, local steroid injection and surgery are the most prevalent therapies.Objective: To find the best clinical path for the treatment of auricular pseudocyst.Methods: Eighty-four subjects were randomly allocated into three equal groups (Group A: simple suction combined with pressure dressing; Group B: suction and local steroid injection; and, Group C: surgery). Two otolaryngologists assessed effective rate, sequelae and degree of satisfaction at three-month follow-up. A visual analog scale was used to determine degree of satisfaction.Results: Group A had the lowest effective rate (54%). Group C was highest in terms of effectiveness (100%) but also in incidence of sequelae (71%). Group B had a slightly lower effective rate (86%) than Group C, but the incidence of sequelae was lowest (42%). Degree of satisfaction was highest (7.0 ± 2.7) for Group B.Conclusion: Local steroid injection should be the first choice for the treatment of auricular pseudocyst because of high satisfaction, favorable effectiveness and few sequelae. Where this method is ineffective, surgery should be used.

Bilateral pseudocyst of the auricles in a 4-week neonate-case report and world literature review

Pseudocyst of the auricle is a rare, idiopathic disease clinically manifesting as a painless edema of the upper-lateral parts of the auricle. Due to the rarity of the disease, auricular pseudocyst is often misdiagnosed. The confirmation of a diagnosis of auricular pseudocyst is most commonly made on the basis of clinical manifestations. The etiology of the disease remains unknown, and this frequently hinders both proper diagnosis and prevention. We report a case of a 4-week neonate admitted to the Department of Pediatrics, Rheumatology and Environmental Diseases of the Chair of Pediatry, Jagiellonian University, Medical College in Krakow with bilateral pseudocyst with very early presentation that was less prominent after birth and well presented in the second week of life. The surgical treatment was successful. One month after treatment the infant was admitted again to the hospital with hypertension and edema of feet and hands. Treatment with amlodipine was implemented resulting in a normalization of blood pressure. The diagnosis of pseudohypoaldosteronism type I was confirmed.

Incision and Drainage with Daily Irrigation for the Treatment of Auricular Pseudocyst

Introduction  Pseudocyst of the pinna is a rare condition that occurs when fluid accumulates in the intercartilagenous space of the auricle. The main goal when treating this condition is to keep acceptable cosmetic results with no recurrence rate.

Objective  To demonstrate the superior impact of incision and drainage of auricular pseudocysts with the insertion of a catheter drain and daily irrigation as the treatment of this condition.

Methods  A total of 42 patients with auricular pseudocysts were enrolled in the present study in the period between May 2011 and May 2017. All of the patients were treated with incision and drainage with compression. The average follow-up time reached ∼ 6 months in all of the cases.

Results  All of the patients had satisfactory cosmetic results with no recurrence and no complications.

Conclusion  Among the different methods of surgical treatment of pseudocyst of the pinna, incision and drainage with daily irrigation is a significantly efficient method both for the eradication of auricular pseudocysts and for good cosmetic results.

Cystic chondromalacia of the auricle treated with dual-plane excision with intracartilaginous dissection

Cystic chondromalacia of the auricle is an uncommon condition in which a degenerative process occurs within the cartilage. The disorder affects young and middle-aged people. Clinically, it manifests as a painless, fluctuant swelling that frequently relapses despite various therapeutic approaches. In this article we report a typical case of cystic chondromalacia of the auricle that was successfully treated by surgery-specifically, dual-plane dissection-and we briefly review the literature.

Pseudocyst of the auricle in patients with movement disorders: report of two patients with ataxia-associated auricular pseudocysts

Background:

Pseudocyst of the auricle is a benign condition of the ear characterized by an asymptomatic, noninflammatory swelling on the lateral or anterior surface of the auricle. It typically presents as a 1 to 5 centimeter cystic lesion located within the scaphoid or triangular fossa. In most patients, the lesion develops spontaneously. However, pseudocyst of the auricle has also been associated with trauma to the ear.

Purpose:

We describe the clinical findings of two men who developed pseudocyst of the auricle associated with ataxia-induced trauma to their ear. We also summarize the differential diagnosis, the postulated pathogenesis, and the treatment options for this condition.

Materials and methods:

The features of two men with pseudocyst of the auricle are presented. Using PubMed, the following terms were searched and relevant citations assessed: ataxia, auricle, dyskinesia, ear, Friedreich’s, neurological, pinna, pseudocyst, spasticity, spinocerebellar, and trauma. In addition, the literature on pseudocyst of the auricle is reviewed.

Results:

Pseudocyst of the auricle was observed in two men with neurological disorders: a 33-year-old Asian man with spinocerebellar ataxia and a 47-year-old Caucasian man with Friedreich’s ataxia. Each patient had a history of ataxia-induced head and ear trauma. The clinical features of the lesions were sufficient to establish a diagnosis of pseudocyst of the auricle. Neither patient desired treatment.

Conclusion:

Pseudocyst of the auricle is a benign cystic lesion that is occasionally precipitated by trauma to the affected ear. Patients with neurological disorders, particularly those associated with ataxia and/or dyskinesias, may have an increased risk of developing the traumatic variant of the condition. Diagnosis can usually be established by clinical presentation. However, in some patients, a tissue specimen may be secured for microscopic evaluation to exclude infection or during surgical repair. Various treatment options exist for pseudocyst of the auricle, including: (1) needle aspiration—with or without subsequent injection of an irritant substance—followed by a pressure dressing and (2) surgical deroofing. Alternatively, reassurance of the benign nature of the condition and observation is a reasonable management alternative.

Novel Modified Surgical Treatment of Auricular Pseudocyst Using Plastic Sheet Compression

Objective

To introduce a novel modified surgical procedure of excision of anterior cartilage of the pseudocyst along with plastic sheet compression for the treatment of auricular pseudocyst and ascertain the effect of the surgical modality of this disease.

Study Design

A retrospective study.

Setting

Medical college hospital.

Subjects and Methods

Eighty-seven auricular pseudocyst patients were subjected to excision of the anterior cartilage of the pseudocyst followed by plastic sheet compression from July 2006 to September 2013. The effects of the operation were evaluated.

Results

Eighty patients were males and 7 were females. The median age was 52 years old. The lesions of 86 patients were unilateral and only 1 was bilateral. The clinical features presented a hemispheric painless swelling, which was seen on the ventral side of the auricle, usually the scaphoid and triangular fossa. The average major axis of the pseudocyst was 1.7 ± 0.6 cm. The patients underwent excision of anterior cartilage of the pseudocyst along with plastic sheet compression. The average follow-up period was 51.9 ± 19.1 months. No recurrence was observed with this technique, and the appearance of the auricle was cosmetically acceptable.

Conclusions

Our novel modified surgical procedure of excision of anterior cartilage of pseudocyst along with plastic sheet compression is an effective surgical management for the auricular pseudocyst. The advantages of a simple technique, a short-term therapeutic period, and no recurrence made the surgical procedure worth recommending as the definitive treatment of auricular pseudocysts.

Treatment of Auricular Seroma

Objective:

Auricular seroma is a cystic swelling filled with serous fluid. It occurs spontaneously or following trauma. Successful treatment of the seroma remains a challenge because this disease has a high propensity for recurrence. The aim was to study the results of the Plaster of Paris (POP) cast in treatment of seroma in terms of complete resolution of swelling, recurrence, and auricular aesthesis.

Study Design:

Prospective.

Setting:

Smt. Kashibai Navale Medical College and General Hospital.

Materials and Methods:

A total of 48 patients with auricular seroma were studied. They were treated with aspiration of the cyst followed by compression dressing with a POP cast, taking the contour of the pinna. The POP cast was kept for 3 days. The patients were followed up for 6 months for recurrence.

Results:

Out of 48 patients, 43 patients had complete resolution of the swelling in a single application of the POP cast. Five patients needed 2 applications of the POP cast. Not a single patient had recurrence. Temporary discoloration or thickening of the pinna was noted in 8 patients. No major complications like perichondritis were noted.

Conclusion:

Aspiration and contour dressing using POP is an innovative and effective treatment for management of auricular seroma as it prevents surgical trauma and recurrence and gives cosmetically excellent results.

Pseudocyst of pinna and its treatment with surgical deroofing: an experience at tertiary hospitals

Introduction:

Pseudocyst of pinna is an uncommon condition hardly encountered in routine ENT practice. The involvement is usually seen in scaphoid, triangular fossa, and antihelix. Medical treatment is ineffective. Various treatments are suggested in the literature. The aims of the paper were to study the clinical characteristic of patients with pseudocysts and to share our experience with surgical deroofing and buttoning as a definitive treatment.

Materials and Methods:

Twenty-six patients were diagnosed with pseudocyst of the auricle between April 2011 and 2013 in two medical college hospitals. Clinical characteristics were noted. All patients underwent incision and drainage with removal of anterior cartilage leaflet followed by buttoning for 12 days.

Results and Observations:

Out of 26 patients, only two were females. Involvement of left side was seen more than right one. None had bilateral involvement. Adults in the age group of 31-40 were commonly affected. Most common site of involvement was scaphoid and triangular fossa. The success rate with primary I and D and buttoning was 96%.

Conclusions:

Pseudocyst of the pinna is a benign condition of unknown etiology affecting the pinna, commonly encountered in middle-aged men. Many modalities of treatment have been recommended in the literature with varied recurrence and failure rates. The best form of treatment with minimum recurrence is incision and drainage with removal of anterior cartilage leaflet with buttoning.

Lactate dehydrogenase isoenzyme patterns in auricular pseudocyst fluid

OBJECTIVE

We investigated lactate dehydrogenase isoenzyme patterns in the cyst fluid of auricular pseudocysts and autogenous blood, to assist the diagnosis of auricular pseudocyst.

METHODS

Twenty patients with auricular pseudocysts participated in this study conducted in Kaohsiung Medical University Hospital between February 2007 and June 2010. Patterns of lactate dehydrogenase in cyst fluid and autogenous blood were analysed.

RESULTS

Levels of lactate dehydrogenase 1 and 2 were lower in auricular pseudocysts than in autogenous blood, whereas levels of lactate dehydrogenase 4 and 5 were higher; this difference was statistically significant (p < 0.001).

CONCLUSION

Lactate dehydrogenase isoenzyme patterns in auricular pseudocyst fluid indicated higher percentage distributions of lactate dehydrogenase 4 and 5 and lower percentage distributions of lactate dehydrogenase 1 and 2. An effective laboratory method of evaluating the different lactate dehydrogenase isoenzyme components was developed; this method may improve the accuracy of auricular pseudocyst diagnosis.

Clinical characteristics and comparative study of different modalities of treatment of pseudocyst pinna

The aims of the article were to study the clinical characteristic of patients with pseudocysts and to compare different common modalities of treatment and introduce the concept of observation in pseudocyst management. Twenty-eight patients were diagnosed with pseudocyst of the auricle between June 2009 and June 2011 in a medical college hospital. The patients were divided into four groups each of seven patients on the basis of primary treatment offered. Four primary treatments offered were simple aspiration, aspiration with intralesional steroid, incision and drainage with removal of anterior cartilage leaflet with buttoning, and lastly, simple observation and reassurance. All 28 patients were male with involvement of right side more than left and no one had bilateral involvement. Adults in the age group of 30-40 were commonly affected. Most of the patients had history of significant trauma by security forces. Most common site of involvement was scaphoid and triangular fossa. The best form of treatment with minimum recurrence was incision and drainage with removal of anterior cartilage leaflet with buttoning. Simple observation as a treatment option was found to be as good as intralesional steroids. Pseudocyst of the pinna is a benign condition of unknown etiology affecting the pinna, commonly encountered in middle-aged men. It is a rare condition and is hardly encountered in routine ENT practice. Bilateral diseases are uncommon. Most common site of occurrence is triangular and scaphoid fossa. Many modalities of treatment have been recommended in literature with varied recurrence and failure rates. The best treatment is surgical deroofing followed by buttoning with minimum recurrences. An option of simple observation for 2-3 months should be discussed with each patient and was found to be as good as intralesional steroids.