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
General Basic Steps—Aspiration
Cleanse
Aspirate
“Milk” hematoma
Pressure dressing
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Maintain pressure on ear for 3 minutes after needle has been withdrawn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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