Incision and Drainage of Hematoma Auris

Overview

Hematoma auris, or auricular hematoma, is a collection of blood in the space between the cartilage of the ear and the perichondrium, the layer of tissue that surrounds the cartilage. Prompt treatment is essential to prevent complications.

This is often resulting from trauma.

Anatomical Layers of the Auricle

From skin to cartilage, the layers are:

1. Skin: The outermost layer.
2. Subcutaneous tissue: Connective tissue beneath the skin.
3. Perichondrium: A layer of fibrous connective tissue surrounding the cartilage.
4. Cartilage: The flexible, yet strong, connective tissue that gives the ear its shape.
5. Blood Supply of the Auricle: The auricle, or pinna, receives its blood supply from the external carotid artery through two main branches:

1. Posterior auricular artery

Supplies the posterior aspect of the auricle.
2. Anterior auricular branches of the superficial temporal artery

Supply the anterior aspect of the auricle.

Blood Supply to the Perichondrium and Cartilage

The perichondrium, a layer of fibrous connective tissue surrounding the cartilage, receives its blood supply from the same arteries that supply the auricle. The blood vessels branch out and form a network of capillaries that supply the perichondrium.

The cartilage itself is avascular, meaning it does not have a direct blood supply. Instead, it relies on diffusion of oxygen and nutrients from the surrounding perichondrium. The perichondrium plays a crucial role in providing the necessary nutrients and oxygen to the cartilage.

Importance of Blood Supply

Understanding the blood supply to the auricle, perichondrium, and cartilage is essential in various clinical contexts, such as:

1. Trauma

Damage to the blood supply can lead to complications, such as hematoma formation or cartilage necrosis.
2. Surgery

Knowledge of the blood supply is crucial for surgical procedures, such as otoplasty or reconstruction of the auricle.
3. Infection

Understanding the blood supply can help in managing infections, such as perichondritis, which can compromise the blood supply to the cartilage.

Epidemiology

Auricular hematomas can occur in anyone, but they are more common in individuals who participate in contact sports or activities that increase the risk of ear trauma.

Pathophysiology

The hematoma forms when blood accumulates between the cartilage and the perichondrium, often due to a shearing force that disrupts the blood vessels.

Aetiological Factors

1. Trauma

Blunt trauma to the ear, such as from a punch or a fall.
2. Contact sports

Participation in sports like wrestling, rugby, or boxing increases the risk.

Symptoms & Signs

Symptoms

1. Pain: The ear may be painful, especially when touched or moved.
2. Swelling: The ear may become swollen and tender.
3. Deformity: The ear may appear deformed or misshapen.

Signs

1. Ecchymosis: Bruising around the ear.
2. Fluctuance: A fluid collection may be palpable.
3. Tenderness: The ear is tender to the touch.

Complications

1. Auricular perichondritis

Infection of the perichondrium.
2. Auricular abscess

A collection of pus in the ear.
3. Cauliflower ear

A deformity of the ear that can occur if the hematoma is not properly treated.

Step-by-Step Procedure of Incision and Drainage

1. Preparation

The area is cleaned and prepared for the procedure.
2. Anesthesia

Local anesthesia is typically used to numb the area.
3. Incision

A small incision is made to access the hematoma.
4. Drainage

The blood is drained from the hematoma.
5. Irrigation

The area is irrigated with saline solution.
6. Packing

The area may be packed with gauze or a bolster dressing to prevent reaccumulating of blood.

Postoperative Management

1. Pain management

Pain relief medication may be prescribed.
2. Antibiotics

May be prescribed to prevent infection.
3. Follow-up

Regular follow-up appointments are necessary to monitor healing and remove any packing.

Note on Auricular Perichondritis, Auricular Abscess, Cauliflower Ear, and Their Managements

1. Auricular perichondritis

Treated with antibiotics and may require hospitalization in severe cases.
2. Auricular abscess

May require incision and drainage, as well as antibiotics.
3. Cauliflower ear

Prevention is key, and prompt treatment of auricular hematomas can help prevent this complication. Treatment may involve draining the hematoma and applying a compressive dressing.

Ear Prosthesis

In cases of severe ear trauma or deformity, an ear prosthesis may be considered as a reconstructive option.

Incision and drainage of hematoma auris, is a procedure that requires careful consideration and proper technique to prevent complications. Prompt treatment is essential to prevent long-term damage and deformity

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