Introduction:
Seromas develop due to trauma to the ear, after surgery, or spontaneously. A cystic swelling that contains fluid in between the perichondrium and cartilage in the upper part of the auricle is known as auricular seroma. The fluid may be amber or straw-colored. Treatment of these cysts is subject to question as they recur more often after the treatment.
What Is Auricular Seroma?
Seromas occur due to the collection of fluids in the body. It is not dangerous but may cause trouble through pain and discomfort. Seroma generally develops after surgery. The fluid which is formed as a part of the healing process in the body enters the body cavity or the site of surgery. Another reason is trauma to the tissues during surgery or due to any reason that may develop inflammation as a body’s response. A cyst developing in the ear due to the collection of clear fluid in the upper part of the ear is known as an auricular seroma and usually forms in between the skin and perichondrium.
Auricular seroma was described by Lapins in 1982 as a separate entity apart from auricular pseudocyst and hematoma. It does not cause cartilage ischemia (insufficient supply of oxygen to the cartilage) like an auricular hematoma; the treatment results in a good cosmetic appearance but have a high tendency for recurrence.
What Is the Cause of Auricular Seroma?
Auricular seroma is also known as pseudocyst, it is rare and does not exhibit any symptoms. The exact cause is not known but repeated trauma that includes sleeping on hard pillows, carrying large weights on the shoulders, and slaps over the ear may cause auricular seroma.
What Are the Treatment Options for Auricular Seroma?
Treatment of auricular seroma is very challenging as it recurs. The aim of treatment is the conservation and restoration of anatomical structures of the pinna, preventing recurrence, and removal of cysts. If left untreated, it may form permanent cauliflower ear deformity due to hardening and fibrosis of the cartilage. Auricular seroma can be treated by the following methods;
-
Needle aspiration.
-
Curettage following incision and drainage.
-
Contour pressure dressing.
-
Deroofing procedure.
-
Insertion of the small drainage tube into the pseudocyst with a guide needle.
Surgical Deroofing:
-
This procedure is done under local anesthesia.
-
An incision (helical) is made based on the position of the seroma.
-
The flap (skin) is raised till the outermost layer of the seroma is seen.
-
Fluid is drained and the cyst is removed along the margins of the pseudocyst.
-
Curettage is done to remove granulation and soft tissue debris from the wall of the cyst.
-
Sutures are placed to bring the flap back to its original position by compressing and after one-week sutures are removed.
The most successful treatment method is anterior deroofing of seroma which has a 96 % success rate. The open deroofing method with Minocycline as a sclerosing agent is one more method preferred. Minocycline reduces IL-6 thereby making it an anti-inflammatory sclerosing agent.
Surgical Deroofing With Compression by Buttons:
It is considered the first line of treatment by many as it gives excellent cosmetic results and restores the anatomical structures of the pinna.
-
Buttons are used to compress the skin flap onto the cartilage. One is used in the anterior and another in the posterior surface of the pinna with sutures.
-
After one week, antibiotics and anti-inflammatory drugs are given to the individual.
-
After one week buttons and sutures are removed.
Surgical Deroofing With Compression by PVC-Derived Sheet:
In this procedure, instead of buttons, plastic sheets are used; but this had a few disadvantages. This method showed a 98.8 % success rate and is not expensive, safe, and can be molded to any size and shape. Complications were not observed in this method.
-
Two plastic sheets were cut into desired sizes and shapes.
-
One is placed on the anterior surface and the other is placed on the posterior surface of the pinna and sutured.
-
The wound is left to dry.
-
After five to six days, the plastic is removed.
-
After one week of the procedure, sutures are removed.
Surgical Deroofing by Sandwich Technique:
In this procedure, cotton balls and rubber tourniquet sheets were used. This has got a 98 % success rate.
-
The cotton ball is soaked in the povidone-iodine solution. Then used for compression.
-
Two rubber tourniquet sheets are taken. One is used in the anterior surface and sutured to a cotton ball and another is sutured to the posterior surface of the pinna.
-
After three days cotton ball is removed.
-
After a week, sutures are removed.
Aspiration With Intralesional Steroid Injections:
This procedure is a simple and minimally invasive technique.
-
The needle is used to aspirate the fluid.
-
The needle is not removed from the site and the syringe with fluid is taken out. It is done to avoid another prick and sagging of the cystic space.
-
Another syringe with steroid solution is attached to the needle and through the same needle, the solution is injected.
-
A spirit-dipped swab is pressed on the site of injection.
Aspiration and Compression Dressing Using Silicone-Derived Material:
This procedure is simple, non invasive and not expensive.
-
Aspiration is done with an insulin syringe.
-
A compression patch is given with silicone-derived material.
-
This dressing is removed after two weeks.
Aspiration Followed by Steroid Injection And Clip Compression Dressing:
The same procedure is explained for a steroid injection.
-
After injecting steroids, a gauze dressing is done.
-
Three u-shaped, curved clips are used to retain the dressing.
Incision and Drainage With Daily Irrigation:
The procedure is done under local anesthesia.
-
The incision is done, one in the upper and another in the lower ends of the cyst.
-
Fluid is drained out, which is done by using a hemostat.
-
The catheter is used to drain the fluid. The upper part of the catheter is stitched to keep it in position. The catheter will have two to three orifices on its body for daily irrigation to be done using betadine and sodium chloride 0.9 %.
-
Once the fluid is removed from the cyst, mastoid dressing is done.
-
Every day mastoid dressing is done after irrigation but only after gauze dressing is done.
Auricular Splinting:
This procedure is done under the aural block.
-
The incision is done parallel to the crus of the antihelix on the pinna.
-
Fluid is squeezed out, and povidone - iodine wash is also done.
-
A corrugated rubber sheet is used to cover the lesion.
-
The splint is used to drain the fluid at the anterior and posterior parts of the splint.
What Are the Complications of Auricular Seroma?
Complications of auricular seroma include
-
Recollection of the fluid.
-
Mild deformation of the pinna.
-
Swelling.
-
Pain.
Conclusion:
Auricular seroma is a fluid-filled cyst that is simple, and noninflammatory in the upper part of the ear. The cause of this condition is not known clearly, but various methods have been used to treat this lesion. Some resolve on their own, but few may require treatment. Hence knowing about the condition encourages one to seek help at the earliest, as early diagnosis helps in achieving effective treatment and a good prognosis.
