[Auricular hematoma--case report of ruptured othematoma and bibliographic review]

Auricular hematoma is not rare condition and its prognosis has been considered to be good in Japanese textbooks. Recurrence of the hematoma, however, frequently occurs by use of simple aspiration or incision, and a pressure dressing. In this paper, we report a case of ruptured othematoma and review the biliographies concerning the pathology and treatment of othematomas. A 37-year-old man sustained a fist blow to his left ear at the beginning of May, 1989. He was first seen with auricular hematoma on July 4, but refused a surgical treatment. The laceration of the skin overlying the hematoma occurred by once more fist blow on July 26, with the upper auricle divided into anterior and posterior parts. The auricular cartilage was broken into several pieces, some of which attached to the anterior side and the others to the posteriors side. Under general anesthesia, fibrin glue was applied to the dead space after irrigation, minimal debridement, and removal of the clots. Four horizontal mattress sutures were put through the entire pinna after the anterior skin was protected by fluffed gauze with antibiotic ointment and the posterior skin by buttons. The dressing was allowed to remain in place ten days and was then removed. Nine months after the operation the pinna appeared almost normal. In recent reports, the othematoma is considered to occur between the perichondrium and the cartilage, or within the cartilage. Various techniques have been applied to treat the othematoma, which are classified into three types: incision and drainage, pressure dressing with splinting mold, or with mattress suture. Treatment of choice is discussed, with reviewing the advantages and disadvantages of each method.