Auricular Hematoma Drainage

imagesA subperichondrial hematoma that separates the perichondrium from the underlying auricular cartilage

   imagesResult of a shearing force to the ear, but can also develop after blunt trauma

   imagesThe hematoma disrupts normal blood supply provided by the overlying perichondrium causing necrosis, fibrosis, and disfigurement of the auricle

   imagesCommonly seen in wrestlers

   imagesEarly diagnosis and treatment is the key—necrosis begins within 24 hours

   imagesIn general, needle aspiration is sufficient. However, if a hematoma reaccumulates, incision and drainage (I&D) may be indicated.

CONTRAINDICATIONS


imagesThere are no absolute contraindications

imagesAnticoagulation is a relative contraindication. Consult with ear, nose, and throat (ENT) specialist if there are any concerns.

RISKS/CONSENT ISSUES


imagesRisk of infection is low. If clinical suspicion is high, an antistaphylococcal antibiotic may be prescribed.

imagesRecurrent and untreated injuries allow new cartilage to develop, which leads to deformity of the auricle (cauliflower ear) (FIGURES 77.1 and 77.2)

LANDMARKS


imagesThe pinna is most commonly involved

imagesThe needle/scalpel is used in the area of greatest fluctuance

imagesGeneral Basic Steps—Aspiration

   imagesCleanse

   imagesAspirate

   images“Milk” hematoma

   imagesPressure dressing

TECHNIQUE


imagesFor needle aspiration, a 10-mL syringe and a 20-gauge needle are required

   imagesCleanse the outer ear with a topical antiseptic (Betadine or chlorhexidine)

   imagesLocal anesthesia is seldom required. If used, avoid epinephrine (causes tissue necrosis).

   imagesStabilize pinna with thumb and fingers

   imagesPuncture area of greatest fluctuance with needle

   images“Milk” hematoma with thumb and index finger until completely evacuated

   imagesMaintain pressure on ear for 3 minutes after needle has been withdrawn

   imagesApply antibiotic ointment and a pressure dressing

   imagesPatient should be advised to avoid strenuous activity

   imagesCheck ear again in 24 hours for reaccumulation of hematoma

   imagesReaspiration may be required, whereas persistent reaccumulation warrants I&D

images

FIGURE 77.1 Compression dressing.

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Auricular Hematoma Drainage

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