Chapter 200: Auricular Hematoma Evacuation

INTRODUCTION

Blunt trauma to the auricle can cause abrasions, ecchymosis, hematoma formation, and lacerations. Abrasions and ecchymosis of the auricle require no therapy other than oral analgesics and observation for infection.¹ Some authors recommend the application of topical antibiotics to all abrasions as prophylaxis for infection.² Lacerations to the auricle are addressed in Chapter 119. This chapter addresses the management of an auricular hematoma.

Injuries to the auricle are common due to its exposed position and lack of protection from surrounding structures.³ The most common cause for an auricular hematoma formation is blunt trauma while participating in the contact sports of wrestling or boxing.^1,2,4-6 Such trauma may occur in other situations including assaults, falls, fights, and motor vehicle crashes. Auricular trauma and hematomas are common in children due to the high incidence of head injuries during playtime.^2,4 Blood dyscrasias may also cause an auricular hematoma.

An auricular hematoma presents as a firm and painful swelling that obscures the normal convolutions on the lateral aspect of the auricle. It can develop within minutes to hours of the blunt trauma. An auricular hematoma must be evacuated to prevent the cosmetic disfigurement known as cauliflower ear.⁷ The sooner it is evacuated, the less chance of permanent disfigurement.^4,5 After evacuation, the patient requires a pressure dressing to the auricle, oral antibiotics, and close follow-up to prevent complications.^2,5,8,9

ANATOMY AND PATHOPHYSIOLOGY

The auricle is that portion of the external ear that projects from the side of the head. It functions to augment sound delivery to the tympanic membrane and assist in sound localization. It is fixed in position by both ligaments and muscles.¹⁰ It has an underlying cartilaginous framework that is 0.5 to 1.0 mm thick and provides the auricle with its unique shape. The cartilage is a single, thin sheet of flexible yellow elastic cartilage with many convolutions on the lateral surface.¹¹ The only portion of the auricle without cartilage is the lobule in which fibrofatty tissue replaces the cartilage.¹⁰ The cartilage is avascular and derives its blood supply and nutrients from the adjacent perichondrium.¹²

The skin covering the auricle is similar to that elsewhere on the body.¹³ It contains sebaceous glands and a varying number of hair follicles. The skin on the lateral surface of the auricle is tightly adherent to the perichondrium and lacks a subcutaneous layer (Figure 200-1). The skin on the medial surface of the auricle is loosely attached and has a layer of subcuticular tissue between the skin and perichondrium.