Pseudocyst of the Auricle Treatment & Management
- Author: William P Baugh, MD; Chief Editor: Dirk M Elston, MD more...
The goals of treatment of pseudocyst of the auricle are preservation of anatomical architecture and prevention of recurrence. Without treatment, permanent deformity of the auricle may occur. Treatment options include needle aspiration with pressure dressings, medication (either systemic or oral), and surgical care. Consensus on the best management for pseudocyst of the auricle is undetermined, and a combination of treatment modalities may be necessary to achieve optimal resolution.
No medical treatment is uniformly effective for pseudocyst of the auricle. High-dose oral corticosteroids and intralesional corticosteroids therapies have been reported, with variable results.[10, 16] Some authors argue against the use of intralesional steroids, implicating them in permanent deformity of the ear, while others support steroid injection therapy or even oral steroid therapy. Advocates of steroid injection therapy consider it a much simpler procedure than surgery. Kim et al report intralesional steroid therapy in combination with a clip compression dressing. Patigaroo et al found that simple observation as a treatment option was found to be as good as intralesional steroids.
Simple needle aspiration of pseudocyst fluid followed by placement of a compressive dressing is one of the most commonly performed methods. However, without use of a pressure dressing, recurrence is common. In one study, the mean time of recurrence of the pseudocyst after aspiration (without subsequent pressure dressing) was 2.3 days. Patigaroo et al used the commonly used technique of simple aspiration followed by intralesional steroid injection followed by pressure dressing. Their success rate was 57% with minimal complications, including thickening of the pinna.[19, 21]
Some have used an auricular prosthesis formulated with the creation of a moulage fitted to the ear by the prosthetist for pressure. Several reports describe a combined procedure using surgical incision and drainage of the lesion, replacement of the anterior skin surface, and the application of a pressure dressing or bolster.[19, 20]
Surgical curettage and fibrin sealant has been shown to be effective in obliterating the cystic cavity. The fibrin sealant works as a template for fibroblasts to move through the wound and serves as a delivery system for growth factor. It also has hemostatic and antibacterial activity.
Intralesional injections of minocycline hydrochloride (1 mg/mL) 2-3 times at 2-week intervals has shown efficacy. Minocycline is thought to work as a sclerosant through its anti-inflammatory and immunomodulatory mechanisms. Other sclerosants used include 1% trichloroacetic acid and tincture of iodine.
An alternative to steroids and conventional surgical incision is a simple punch biopsy followed by the application of a bolster for approximately 2 weeks. This method should be a welcome alternative for physicians who choose to not use steroids. This simple alternative method provides a safe and effective mechanism for diagnosis and treatment of this phenomenon, while minimizing the risk of deformity. Successful treatment of an auricular pseudocyst using a surgical bolster is reported in the literature.[26, 27] Shan et al reported success with surgical treatment using plastic sheet compression.
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|Pseudocyst of the auricle||Chondrodermatitis chronica helices||Relapsing polychondritis||Subperichondrial hematoma|
|Skin involvement||Rare||Yes, crusting/ulceration||Yes, erythematous||Rare|
|Pain||Rare||Common (from ulceration)||Common (extremely tender)||Common|
|Systemic Symptoms||No||No||Yes (involvement of other cartilage)||No|
|Histology||racartilaginous, cystic defect, granulation tissue||Subperichondrial granulation tissue, cystic dilatation rare||Acute inflammable cells seen; antibody deposition on basement membrane during immunofluorescence||Inflammatory cells with degraded blood products|
|Adapted from Lim CM, et al. “Pseudocyst of the Auricle.” 2002.|