Auricular hematoma

Question 1

Where does blood accumulate in an auricular hematoma?

Answer 1

subperichondrial space (between the perichondrium and cartilage)

Question 2

What supplies blood to the auricular cartilage?

Answer 2

perichondrium

Question 3

What are some DDx for auricular hematomas?

Answer 3

Perichondritis, chondritis, auricular abscess

Question 4

What’s a common Hx seen with perichondral infections?

Answer 4

break in helical ear (piercing/laceration)

Question 5

What is an uncommon autoimmune condition in adults that can mimic traumatic cauliflower ear?

Answer 5

Relapsing polychondritis

Question 6

Auricular hematomas greater than how many days warrant referral to an otolaryngologists or plastic surgeon?

Answer 6

greater than seven days

Question 7

What analgesia technique is used prior to draining an auricular hematoma?

Answer 7

regional auricular block

Question 8

what size auricular hematomas are good candidates for needle aspiration vs incision and drainage?

Answer 8

< 2cm in diameter and present up to 48 hours

Question 9

List the steps for needle aspiration of a small acute auricular hematoma:

Answer 9

Cleans with providone-iodine solution
Provide local anesthesia
Identify and aspirate most fluctuant part with 18 gauge needle while milking hematoma
Apply pressure for 5-10 minutes and place pressure dressing

Question 10

How often should patients f/u after evacuation of an auricular hematoma?

Answer 10

every 24 hours x 3-5 days

Question 11

What type of suture should be used to close the incision and drainage of an auricular hematoma?

Answer 11

mattress suture using 5-0 monocryl or fast absorbing gut or 5-0 nylon or Prolene

Question 12

List the steps to place an intravenous catheter to evacuate an auricular hematoma:

Answer 12

Cleanse ear with antiseptic
Provide local anesthesia
insert 18 gauge IV into inferior boarder of hematoma
Attach a syringe and evacuate
Remove needle but leave catheter
Clip catheter so approx. 1 cm protrudes from insertion site
Dress

Question 13

after how many days should non-absorbable sutures be removed from incision site of auricular hematoma?

Answer 13

7-10 days

Question 14

for how long should a pressure dressing be applied after treating an auricular hematoma?

Answer 14

72 hours, changed daily for wound checks

Question 15

What empiric antibiotics are recommended for patients undergoing auricular hematoma drainage?

Answer 15

abx with activity against Pseudomonas aeruginosa
Lefofloxacin
Amoxicilin and Clavulanic acid