Treatment of auricular hematoma using button technique

Use of Thermoplastic Splint for the Treatment of Auricular Hematoma

Auricular hematoma is commonly seen in ear nose and throat clinical practice and mostly caused by blunt trauma as a result of traffic accident, wrestling, boxing etc. If hematoma does not discharge, blood supply of the cartilage fails and this results with the necrosis of the auricular cartilage. Incision and drainage of the hematoma is the cornerstone of the surgical treatment and simple compression methods are limited in terms of their ability to eliminate the empty space. Various techniques have been described for the elimination of the death space such as; dental rolls, cotton bolsters, buttons, silastic sheets, etc but compression materials may be insufficient to apply this pressure because of irregular shape of auricle. Resolving these problems, the authors have used thermoplastic splint as a compressive material at 7 patients for elimination of the death space in auricular hematoma treatment.

Pressure appliance to prevent the recurrence of auricular seroma: A new clinical trial

STATEMENT OF PROBLEM

Auricular swellings significantly affect the facial aesthetics. Swelling affecting the pinna can lead to overt disfigurement and change the entire appeal of the face. Gross deformity can occur because of a delay in diagnosis and mismanagement. In our clinical trial fabrication of a simple, effective innovative pressure appliance for auricular seroma is presented to prevent such changes.

METHOD

Our case report comprises of a new clinical trial on a patient with auricular seroma referred from the department of ENT, M.S. Ramaiah medical hospital, Bangalore, Karnataka. A 19-gauge stainless steel wire (Leo wire, Leone, Italy) and chemically cure resin was used to fabricate the pressure appliance to prevent the recurrence of auricular seroma.

RESULT

Patient was successfully treated with the help of pressure appliance after 8 weeks of follow up.

CONCLUSION

This appliance is a masked alternative to conventional pressure dressing after drainage of auricular seroma which does not pose embarrassment for patient to apply. The use of such an appliance will ensure patient compliance, thereby preventing long term auricular deformity.

Treatment of auricular hematoma by OK-432

Objectives: Intralesional injection therapy with OK-432 was developed as a therapy for operatively difficult lymphangioma (cystic hygroma) and is currently becoming a first-choice treatment for this disease. The aim of this article was to evaluate the outcome and complications of the treatment of patients with auricular hematoma by OK-432 therapy.

Study Design: Case series with planned data collection.

Setting: Yamagata University School of Medicine.

Subjects and Methods: We tried this therapy in 21 patients with auricular hematoma between January 2001 and February 2009. We injected OK-432 solution into the lesion with a 27-gauge needle to prevent the leak of the agent out of the hematoma. We performed this treatment on an outpatient basis without hospitalization.

Results: Disappearance or marked reduction of the lesion were observed in all patients who had this therapy, and local scarring and deformity of the auricle did not occur in any patients. As for side effects, local pain at the injection site and fever (37°C-38°C) were observed in a few of the patients who had this therapy, but such problems resolved within a few days.

Conclusion: These results may allow us to speculate that intralesional injection therapy with OK-432 is simple, easy, safe, and effective and can be used as a substitute for surgery in the treatment of auricular hematoma.

Pseudocyst of pinna: a recurrence-free approach

OBJECTIVE

The aims of the article were to study the epidemiological profile of pseudocyst of pinna in non-Chinese population, to propose a hormonal basis of pseudocyst formation, and to compare 2 commonly used treatment modalities of incision drainage with compression and deroofing with compression, so as to ascertain the definitive treatment of this frequently recurring condition.

MATERIAL AND METHODS

Twenty-nine patients were diagnosed with pseudocyst of the auricle between June 2005 and December 2006 in a medical college hospital. All the patients were initially subjected to aspiration with contour dressing. Of the 29 patients, 28 showed recurrence with in 1 week. These 28 patients were divided into 2 groups--13 patients underwent incision and drainage with curettage followed by buttoning, whereas 15 underwent surgical deroofing of the cyst along with buttoning.

RESULTS

All the 29 patients were males with a mean age of 32.6 +/- 4.3 years. Sixteen (55.17%) patients had a right-sided lesion, whereas 13 (44.82%) patients had a left-sided lesion. No case of bilateral pseudocyst was seen. The pseudocyst was most commonly located in the concha. After aspiration with contour dressing, 28 (96.55%) patients showed recurrence within 1 week. Of the 13 patients who underwent incision drainage with buttoning, 5 (38.46%) showed recurrence. Of the 13 patients who underwent incision drainage, 3 (23.07%) showed permanent thickening of the auricular cartilage. The 5 cases that recurred then underwent deroofing with buttoning along with 15 patients. Thus, a total of 20 patients underwent surgical deroofing. No recurrence was seen with this technique. The patients were followed up for 1 month. No complication was noted, and the results were cosmetically acceptable.

CONCLUSION

Pseudocyst of the pinna is an uncommon condition of the auricle presenting as a painless swelling in young adult males. The epidemiological profile of this condition is similar in Chinese and non-Chinese (Indian) population. A hormonal influence modulating the inflammatory process explains the marked male predominance of this condition. Surgical deroofing followed by buttoning is the definitive treatment of this entity as it is associated with no recurrence and gives a cosmetically acceptable result.

Pseudocyst of auricle - etiopathogenesis, treatement update and literature review

Pseudocyst of the pinna, a benign idiopathic cystic swelling is an uncommon condition. In the medline search there are over 113 cases reported in literature. Engel in 1966 reported the incidence in Chinese community. In this review article we describe the etiopathogenesis, demographic statistics and treatment modalities.This is a retrospective study of six cases treated by the senior author in the dept of Otorhinolaryngology, Head & Neck Surgery, Apollo Hospital Chennai, South India between 1993 through 2003. There is preponderance of incidence in adult male (5 cases) and a single case in a female. The author highlights the modalities of treatment and opines that the surgical technique described by Lim et al, with little modification is the gold standard, which retains the architecture of the pinna. Conservative methods adopted by others have failed.

Rethinking Auricular Trauma

OBJECTIVES/HYPOTHESIS

An unrecognized auricular hematoma can lead to a disfiguring deformity, the cauliflower ear, but it can be prevented with prompt and comprehensive management. Fine needle aspiration with pressure bandages remains the mainstay treatment but will occasionally fail. We review our experience with recurrent or recalcitrant auricular hematomas in terms of their pathophysiology and revision surgery.

STUDY DESIGN

Retrospective chart review.

METHODS

A review of patients undergoing surgical incision, drainage, and debridement secondary to recurrent auricular hematomas was conducted. Demographic data was collected, intraoperative notes were reviewed, and follow-up results were obtained. Our management included an open incision, aggressive debridement, and long term bolsters to the ear.

RESULTS

Ten patients presented with a persistent auricular hematoma and deformity following outpatient management with either incision and drainage or fine needle aspiration. All were male with a mean age of 25 years, presenting for surgery on average 19 days following initial trauma. The location of the hematoma within this group was not limited to the potential space between the cartilage and perichondrium. The hematoma was clearly located within the cartilage itself and it is postulated that this is one of the primary reasons for initial failure. Following surgical incision and drainage there were no recurrences or complications.

CONCLUSION

There is a select group of patients with refractory auricular hematomas that require more aggressive treatment over a fine needle aspiration. Open debridement is indicated for this group. The location of the hematoma, granulation tissue, and neo-cartilage is found to be within the cartilage itself rather than between the cartilage and perichondrium, thus explaining why a needle aspiration alone can be ineffective.

Interventions for acute auricular haematoma

BACKGROUND

Acute haematoma of the pinna is a condition where a collection of blood forms beneath the perichondrial layer of the pinna. It is usually caused by blunt trauma, and if untreated will ultimately result in a deformity commonly known as 'cauliflower ear' or 'wrestler's ear'. Various treatments are employed to relieve the haematoma but no clear consensus exists on the best way to do so in order to produce the best cosmetic result with the least permanent deformity.

OBJECTIVES

To assess the effectiveness of treatment options in acute auricular haematoma.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 2, 2003), MEDLINE (1966 - 2003) and EMBASE (1966 - 2003) with pre-specified terms. The date of the last search was April 2003.

SELECTION CRITERIA

Randomised controlled trials, case controlled trials and cohort studies including children and adults undergoing any intervention for acute auricular haematoma.

DATA COLLECTION AND ANALYSIS

Fifty-nine references were identified from the searches. Forty-eight were retrieved and assessed for eligibility by the authors. None met the inclusion criteria.

MAIN RESULTS

Due to the lack of data from trials fulfilling selection criteria no results could be presented.

REVIEWERS' CONCLUSIONS

There is no clearly defined best treatment for acute auricular haematoma. There are no good quality data to determine either the optimal management strategy or even whether post-drainage intervention (such as splinting or bandaging) is necessary. Further research is required before any specific treatment may be recommended.

Pseudocyst of the auricle

OBJECTIVE

To study the epidemiological profile of patients with pseudocyst of the auricle and to review the effectiveness of surgical excision of the anterior cartilage with compression buttoning in this condition.

STUDY DESIGN

Medical records of patients with pseudocyst of the auricle treated in the Department of Otolaryngology of the Singapore General Hospital were reviewed retrospectively during the period from March 1, 2000, to November 30, 2001.

METHODS

A retrospective descriptive analysis of the epidemiological profile of patients with pseudocyst of the auricle was done. Surgical excision with compression buttoning was evaluated as the definitive treatment in this condition.

RESULTS

Eighty-seven percent of our patients were male and the mean age was 38.9 years old. There was no racial predisposition. All 9 patients who had simple aspiration of the cyst had prompt re-accumulation of the pseudocyst. None of the patients had recurrence following excision and compression buttoning of the pseudocyst. The complication rate in our study was 2.4%. Only one patient developed initial perichondritis with a resultant cauliflower deformity following surgical excision.

CONCLUSION

Pseudocyst of the auricle typically presents as a painless unilateral swelling of the auricle in young adult males. Treatment options are varied. Excision of the anterior cartilage with compression buttoning yielded excellent results with no recurrence.

Pseudocyst of the auricle: successful treatment with intracartilaginous trichloroacetic acid and button bolsters

Pseudocyst of the auricle is an asymptomatic, noninflammatory cystic swelling that typically involves the anthelix of the ear and results from an accumulation of fluid within an unlined intracartilaginous cavity. We report a patient with a recurrent pseudocyst of the auricle and describe a new surgical technique for treating this condition by applying 50% trichloroacetic acid to the intracartilaginous cavity and utilizing external button bolsters for compressive therapy. This therapeutic approach is simple to perform in the office, results in permanent resolution of the pseudocyst, preserves the normal architecture of the external ear, and provides excellent postoperative and long-term cosmetic results.

Preventing Cauliflower Ear With a Modified Tie-Through Technique

In brief: Hematoma following trauma to the external ear is a common problem among wrestlers and boxers. If the hematoma is not treated promptly, infection, fibrosis, scarring, and calcification may develop, leading to the gross deformity known as cauliflower ear or wrestler's ear. Evacuation of the hematoma followed by compression of the auricle is commonly regarded as the treatment of choice. However, fluid frequently reaccumulates after this procedure. The authors describe a tie-through suture technique in which a collodion packing is secured to the auricle with two buttons. Multiple treatments for fluid reaccumulation are rarely necessary when this technique is used.

Button bolsters in dermatologic surgery

Ordinary plastic buttons may be used as bolster devices to relieve tension across wounds. This article describes the method of placement of those "button bolsters" and suggests two methods of closing the wound once they are in place. This simple technique is easily mastered and gives additional wound closure security in the initial phase of wound healing.

Silicone ear splints in the management of acute haematoma auris

A discussion of the rationale of management of acute haematoma auris and a description of a simple, reliable method of management using Otoform K Silicone impression material to form ear splints.