Pseudocyst of the Auricle Treatment & Management

Updated: Nov 07, 2019
  • Author: William P Baugh, MD; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Medical Care

The goals of treatment of pseudocyst of the auricle are preservation of anatomical architecture and prevention of recurrence. [19, 20] 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. [8, 21] 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. [22] 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. [23] Patigaroo et al found that simple observation as a treatment option was found to be as good as intralesional steroids. [24]

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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. [25] 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. [24, 26]

Surgical

Some have used an auricular prosthesis formulated with the creation of a moulage fitted to the ear by the prosthetist for pressure. [27] 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. [24, 25]

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. [15]

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. [28] Other sclerosants used include 1% trichloroacetic acid [29] 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. [30] 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. [31, 32] Shan et al reported success with surgical treatment using plastic sheet compression. [33]

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Complications

One study reported a patient who developed initial perichondritis following excision, requiring treatment with intravenous antibiotics. The perichondritis resolved, but with a resultant cauliflower ear 3 months after the surgery. Authors proposed that since the patient was an elderly woman with diabetes mellitus, the underlying comorbidity may have contributed to the unfavorable outcome. [25]

One report stated the potential risk associated with compressive techniques, such as a compressive ear splint for pressure application, may include pressure necrosis if the device is too tight. Proper application and instructing the patient to remove the device and examine for redness of the ear several times daily will aid in prevention. [27]

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