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Auricular Hematoma
Aka: Auricular Hematoma, Pinna Hematoma, Aural Hematoma, Ear Hematoma, Cauliflower Ear, Auricular Bolster, Auricular Compression Dressing
- Risk Factors: Sports Injury
- Wrestling
- Boxing
- Polo
- Water
- Rugby
- Pathophysiology
- Repeated auricle blunt and shearing Trauma (although some cases may be spontaneous)
- Perichondrium separates from cartilage
- Allows blood to accumulate around cartilage (subperichondrial space)
- Results in interruption of cartilage perfusion with risk of necrosis
- Signs
- Fluctuant bluish swelling of anterior superior auricle
- Management: Decompression
- Prepare the skin with betadine or hibiclens
- Anesthetize the auricle with Ear Field Block
- Perform with sterile technique to prevent infection (perichondritis)
- Drainage
- Needle aspiration with 18 gauge or larger needle OR
- Incision (1-2 cm superficial incision) and drainage
- Apply Auricular Bolster (compression dressing)
- See below
- Prevents reaccumulation
- Management: Auricular Bolster (compression dressing)
- Indications
- Auricular Hematoma
- Auricular Laceration (consider)
- Preparation
- Ear Anesthesia (see Ear Field Block)
- Skin preparation (e.g. betadine or hibiclens)
- Nylon Suture (e.g. Ethilon) 3-0 or 4-0
- Material for 2 Bolsters
- Dental rolls
- Folded 2x2 gauze
- Rolled Xeroform gauze (e.g. adaptic)
- Lubricant
- Bacitracin or Xeroform gauze applied to surface of bolster to keep from adhering
- Technique
- Sandwich auricle between two bolsters
- Suture through the first bolster, auricle, and second bolster and tie
- Repeat suturing at a second location along the bolster
- Apply additional compressive dressing over the top of the ear and wrapped around the head
- Resources
- Brown EM Residency Video
- https://www.youtube.com/watch?v=sIlm7vPs3q8
- Management: General
- Other measures
- Many ENTs will start Augmentin while treating Auricular Hematoma
- Update Tetanus status
- Wear protective ear equipment to prevent reinjury
- Follow-up
- Re-evaluation in 18-24 hours to exclude reaccumulation (and need for repeat hematoma drainage)
- Complications
- Cauliflower Ear
- Irreversible External Ear deformity from inadequately drained clot and fibrous deposition
- References
- Dreis (2020) Crit Dec Emerg Med 34(7):3-21
- Claudius, LoTempio, Behar and Swaminathan in Herbert (2016) EM:Rap 16(8): 2-3