Surgical deroofing in the treatment of patients with auricular pseudocyst

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.

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.

Auricular Pseudocyst: Sonographic Appearance in 17 Patients

Auricular pseudocyst (AP) is a rare benign condition that corresponds to an intracartilaginous collection resulting in a noninflammatory cystic swelling of the ear.The objective is to describe ultrasound and clinical presentation of histologically proven AP.An Institutional Review Board (IRB) approved a 6-year retrospective study. Patients with an auricular pseudocyst were selected. Fifty-nine percent of the cases were referred with clinical suspicion of AP. One hundred percent were men, and in 76% of the cases, AP was located in the scaphoid fossa. The mean age was 35 years (76% from 20 to 50 years).Unilateral lesion was present in 94% of the cases. A single lesion was found in 88% and multiple lesions in 12%. On high-resolution ultrasound increased thickness of the cartilage was observed in all patients with a cystic lesion inside the cartilage. Fifty-nine percent of the cases were totally anechoic. The other presented echoes or septa inside the cystic lesion.In conclusion high-resolution ultrasound allows to study the exact anatomic involvement of the cartilage and the surrounding tissues. The auricular pseudocyst presented a characteristic ultrasound finding permitting an adequate early diagnosis and monitoring treatment. Knowledge of this pathology and the sonographic finding is important for a correct diagnosis.

Anterior wall resection plus radiofrequency ablation versus simple aspiration in the treatment of auricular pseudocyst: a retrospective study

Objective

To compare the efficacy of two different treatment approaches for auricular pseudocyst.

Methods

This retrospective study reviewed data from patients with auricular pseudocyst that were treated with either anterior wall resection plus radiofrequency ablation compression (surgical group) or simple aspiration and compression suturing (control group). The following outcomes were compared between the two groups: therapeutic response (cure, good or none), duration of postoperative medication (antibiotics) use, duration of postoperative pain, duration of recovery of appearance and rate of complications (infection, auricular thickening, incision swelling and recurrence).

Results

A total of 386 patients were enrolled in the study: 218 in the surgical group and 168 in the control group. Duration of postoperative medication use, duration of postoperative pain, duration of recovery of appearance and rate of postoperative complications were significantly lower in the surgical group compared with the control group. The overall therapeutic response (cure and good response) was significantly greater in the surgical group than in the control group.

Conclusion

Auricular pseudocyst can be effectively treated by both of these methods, but anterior wall resection plus radiofrequency ablation compression might be more effective.

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.