Auricular hematoma

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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
Auricular hematoma

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

Maxillofacial Trauma

Orbital trauma

Acute

Subacute/Delayed

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

Procedure

Ear anatomy
  1. 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 gentle suction or curettage
    • Option 2: Use large-bore needle/syringe to aspirate hematoma[2]
      • Needle aspiration generally is not sufficient treatment[3], especially for larger hematomas
  2. Prevent re-accumulation of hematoma (goal is to close the dead space between perichondrium and cartilage[1]). Multiple methods available:
    • Option 1: Compression dressing rather than simple 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])
    • 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]
  3. Antibiotics

Disposition

  • Discharge

See Also

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