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

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

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

    Commonly seen in wrestlers

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

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

CONTRAINDICATIONS

 There are no absolute contraindications

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

RISKS/CONSENT ISSUES

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

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

LANDMARKS

 The pinna is most commonly involved

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

TECHNIQUE

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

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

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

    Stabilize pinna with thumb and fingers

    Puncture area of greatest fluctuance with needle

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

    Maintain pressure on ear for 3 minutes after needle has been withdrawn

    Apply antibiotic ointment and a pressure dressing

    Patient should be advised to avoid strenuous activity

    Check ear again in 24 hours for reaccumulation of hematoma

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

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