Hematoma

A hematoma can develop from almost any type of trauma to the ear. As a result of the lack of subcutaneous fat on the anterior surface of the auricle, blunt force applied to this area tends to shear the perichondrium from the underlying cartilage and tear the adjoining blood vessels. The cartilage depends on the perichondrial blood vessels for viability. Any separation can result in necrosis. In addition, a subperichondral collection can lead to stimulation of the overlying perichondrium, which can result in an asymmetrical formation of new cartilage and deformity of the auricle. The resultant deformed auricle has been referred to as "cauliflower ear," which was fairly common in wrestlers and boxers of the past. The auricular hematoma itself presents as a painful swelling after trauma, which obscures the normal contour of the ear. The hematoma may accumulate immediately or several hours after the insult; if it is large enough, it may have an ecchymotic hue. In the past, the advised treatment was aspiration of the hematoma. More current literature suggests that aspiration alone does not completely evacuate the clot and therefore leads to deformity and increased morbidity. The goal of treatment is to remove the fluid collection and maintain pressure in the area for several days to prevent reaccumulation of fluid.2 25 After local anesthesia, and using sterile technique, a circular incision should be made through the skin with caution not to violate the underlying perichondrium. The incision should be the minimal necessary to drain the underlying hematoma and positioned in an area with the least exposure (the inner curvature of the helix or anthelix). The hematoma can then be removed by gentle suction or curettage. 2 ^i26.,2.7 and28

A dental roll or a firm sterile pledget can then be placed over the resutured site with through-and-through sutures connected to a similar bolster on the opposite side. 22 A nonpressure dressing with antibiotic ointment should then be applied and the patient given instructions as to reevaluation within 24 h to assure there has been no reaccumulation. Prophylactic antibiotics can be reserved for immunocompromised patients and should cover P. aeruginosa and Staphylococcus aureus, the two likely participants in posttraumatic chondritis.

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