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Pseudocyst of the Auricle Treatment & Management

  • Author: William P Baugh, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Nov 12, 2014
 

Medical Care

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.[17] 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.[18] Patigaroo et al found that simple observation as a treatment option was found to be as good as intralesional steroids.[19]

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Surgical Care

Aspiration

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.[20] 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]

Surgical

Some have used an auricular prosthesis formulated with the creation of a moulage fitted to the ear by the prosthetist for pressure.[22] 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.[12]

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.[23] Other sclerosants used include 1% trichloroacetic acid[24] 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.[25] 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.[28]

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Contributor Information and Disclosures
Author

William P Baugh, MD Assistant Clinical Professor of Dermatology, Western University of Health Sciences; Medical Director, Full Spectrum Dermatology; Consulting Staff, Department of Dermatology, St Jude Medical Center

William P Baugh, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Laser Medicine and Surgery, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Coauthor(s)

Cynthia L Chen, DO, DO Intern, Pacific Hospital of Long Beach, California

Cynthia L Chen, DO, DO is a member of the following medical societies: American Osteopathic Association, California Medical Association, American Osteopathic College of Dermatology, Los Angeles County Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Kelly M Cordoro, MD Assistant Professor of Clinical Dermatology and Pediatrics, Department of Dermatology, University of California, San Francisco School of Medicine

Kelly M Cordoro, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Medical Society of Virginia, Society for Pediatric Dermatology, Women's Dermatologic Society, Association of Professors of Dermatology, National Psoriasis Foundation, Dermatology Foundation

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Mark L. Welch, MD, and Hon Pak, MD, to the development and writing of this article.

References
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  19. Patigaroo SA, Mehfooz N, Patigaroo FA, Kirmani MH, Waheed A, Bhat S. Clinical characteristics and comparative study of different modalities of treatment of pseudocyst pinna. Eur Arch Otorhinolaryngol. 2011 Oct 29. [Medline].

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Asymptomatic nodule on the left ear.
Low magnification of this pseudocyst reveals a mucin-containing cystic cavity.
Table. Comparison of Characteristics of 4 Auricular Conditions.
  Pseudocyst of the auricle Chondrodermatitis chronica helices Relapsing polychondritis Subperichondrial hematoma
Swelling Localized Localized Diffuse Localized
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.
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