Where does blood accumulate in an auricular hematoma?
subperichondrial space (between the perichondrium and cartilage)
What supplies blood to the auricular cartilage?
perichondrium
What are some DDx for auricular hematomas?
Perichondritis, chondritis, auricular abscess
What’s a common Hx seen with perichondral infections?
break in helical ear (piercing/laceration)
What is an uncommon autoimmune condition in adults that can mimic traumatic cauliflower ear?
Relapsing polychondritis
Auricular hematomas greater than how many days warrant referral to an otolaryngologists or plastic surgeon?
greater than seven days
What analgesia technique is used prior to draining an auricular hematoma?
regional auricular block
what size auricular hematomas are good candidates for needle aspiration vs incision and drainage?
< 2cm in diameter and present up to 48 hours
List the steps for needle aspiration of a small acute auricular hematoma:
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
How often should patients f/u after evacuation of an auricular hematoma?
every 24 hours x 3-5 days
What type of suture should be used to close the incision and drainage of an auricular hematoma?
mattress suture using 5-0 monocryl or fast absorbing gut or 5-0 nylon or Prolene
List the steps to place an intravenous catheter to evacuate an auricular hematoma:
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
after how many days should non-absorbable sutures be removed from incision site of auricular hematoma?
7-10 days
for how long should a pressure dressing be applied after treating an auricular hematoma?
72 hours, changed daily for wound checks
What empiric antibiotics are recommended for patients undergoing auricular hematoma drainage?
abx with activity against Pseudomonas aeruginosa
Lefofloxacin
Amoxicilin and Clavulanic acid
