[20] Auricular Haematoma

Question 1

What is an auricular haematoma?

Answer 1

A complication resulting from direct trauma to the anterior auricle

Question 2

What arteries form the blood supply to the auricle?

Answer 2

• Posterior auricular artery
• Anterior auricular branch of the superficial temporal artery
• Occipital artery

Question 3

What happens in auricular haematoma?

Answer 3

There is tearing of the perichondral blood vessels in the auricle

Question 4

What cause tearing of the perichondral blood vessels in the auricle?

Answer 4

Shearing forces on the auricle leading to separation of the anterior auricular perichondrium from the underlying, tightly adherent cartilage

Question 5

What can happen as a result of perichondral blood vessels tearing and haematoma formation?

Answer 5

Compromise of the avascular underlying cartilage

Question 6

What can result if an auricular haematoma is left untreated or is treated inadequately?

Answer 6

Cauliflower ear

Question 7

What are the most common causes of auricular haematoma?

Answer 7

• Sports injuries
• Earring placement
• RTA

Question 8

What sports commonly cause auricular haematoma?

Answer 8

• Rugby
• Wrestling
• Boxing

Question 9

What is often present in the history of a patient with auricular haematoma?

Answer 9

Trauma

Question 10

What are some typical symptoms of auricular haematoma?

Answer 10

• Pain
• Paraesthesia
• Ecchymosis

Question 11

What symptoms make a diagnosis of auricular haematoma less likely?

Answer 11

• Erythema
• Warmth
• External auditory canal swelling
• Hearing loss

Question 12

What examination findings are typical of auricular haematoma?

Answer 12

• Contour irregularity

- Swelling and fluctuant area overlying the ear’s cartilaginous portion

Question 13

What investigations may be useful in auricular haematoma?

Answer 13

• USS

- CT or MRI

Question 14

Does auricular haematoma require investigations?

Answer 14

Not usually

Question 15

Why may USS be useful in auricular haematoma?

Answer 15

To evaluate the swelling and rule out auricular abscess

Question 16

When might a CT or MRI be used in auricular haematoma?

Answer 16

If significant trauma has occurred and there is concern for a foreign body or abscess and middle or inner ear need assessing

Question 17

What are the differentials for auricular haematoma?

Answer 17

• Perichondritis
• Auricular abscess
• Cellulitis
• Temporomandibular disorder
• Laceration
• Normal anatomical variance
• Skin cancer

Question 18

When is drainage of auricular haematoma appropriate?

Answer 18

If it occurred within 7 days

Question 19

How can an auricular haematoma be drained?

Answer 19

• Incision and drainage

- Needle aspiration

Question 20

What sort of dressing should be applied after drainage of auricular haematoma?

Answer 20

Compression dressing

Question 21

What are the complications of auricular haematoma drainage?

Answer 21

• Reaccumulation
• Site infection
• Chondritis
• Scar formation

Question 22

What may complicate drainage of auricular haematoma after 7 days?

Answer 22

Formation of granulation tissue

Question 23

What must patients be informed about when refusing treatment for auricular haematoma?

Answer 23

Risk of permanent cosmetic outcomes

Question 24

What is the main complication of auricular haematoma?

Answer 24

Cauliflower ear

Question 25

What is the typical appearance of cauliflower ear?

Answer 25

Mis-folded ear with several soft tissue humps abnormally located in the ear