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You are seeing a 15 year old boy who was “jumped” by a group of boys at school today and hit in the head area. He has a 3cm diameter tender ecchymotic area that is swollen and fluctuant on the auricle of his left ear, in the scaphoid fossa, which is the area between the helix and antihelix.
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October 31, 2023 at 11:57 am
C) Needle aspiration is an alternative to I&D for smaller similar swellings (<2cm)
The vignette is describing auricular hematoma, a subperichondrial collection of blood which commonly results from blunt trauma to the ear and is associated with sports such as wrestling, boxing, and rugby. Drainage of the hematoma is important because otherwise the pressure of the hematoma on the poorly vascularized ear cartilage can lead to cartilage malformation aka “cauliflower ear” deformity. Standard treatment is timely I&D, followed by a pressure dressing to make sure the blood does not reaccumulate – this can be accomplished by placing mattress sutures in the area, or by sewing a bolster into place on each side of the auricle. Tissue adhesive would not accomplish an adequate dressing. Anesthesia is achieved by a field block with local anesthetic placed in a diamond shape around the entire ear. The signs in answer A are associated with basilar skull fracture, not auricular hematoma.