220  Auricular splint in pseudocyst Original Article

An Economical Method of Auricular Splinting in

Management of Auricular Pseudocyst

Karthik Rao*, Mohan Jagade, Vitthal Kale, Dev Kumar, Amol Hekare

Grant Medical College and Sir JJ Group of ABSTRACT

Hospitals, Mumbai, Maharashtra, India
BACKGROUND
Pseudocyst of the auricle is a common benign disease. Many
treatment modalities have been described for this benign condition
ranging from simple aspiration to complex cutaneous surgeries
involving skin de-roofing and debridement with diamond burr.
the aim of treatment is to successfully resolve the seroma without
damaging the underlying healthy cartilage, thus maintaining the
normal contour of the auricle, and to prevent its recurrence.
METHODS
In this study we describe incision and drainage of the pseudocyst
with auricular splinting.
RESULTS
Resolution was seen in 100.00 %, skin discolouration in 33.33%,
skin thickening in 29.63% and deformity in 25.93% of the patients.
CONCLUSION
The use of corrugated drain sheet splint is an ingenious method
of aural pseudocyst management. This method is simple and
can be performed by even less experienced surgeons and highly
economical which prevents the recurrence and maintains the
auricular aesthetics.

KEYWORDS
Auricular; Splinting; Pseudocyst; Management

Please cite this paper as:

Rao K, Jagade M, Kale V, Kumar D, Hekare A. An Economical Method
of Auricular Splinting in Management of Auricular Pseudocyst. World
J Plast Surg 2018;7(2):220-225.

INTRODUCTION

Pseudocyst of the auricle is a common benign disease more

predominant in the Chinese population,1 characterized by
spontaneous, asymptomatic swelling over the anterior aspect of
the auricle. Many treatment modalities have been described for
*Corresponding Author: this benign condition ranging from simple aspiration to complex
Karthik Rao, cutaneous surgeries involving skin de-roofing and debridement
Grant Medical College and Sir Jamshed-
with diamond burr. Multiple intralesional therapies have also
jee Jeejeebhoy Group of Hospitals,
Mumbai, Maharashtra, India
been tried with corticosteroids, 50% TCA and Bleomycin with
E-mail: karthik.nag.rao@gmail.com displeasing results. Thus the aim of treatment is to successfully
Received: October 7, 2016 resolve the seroma without damaging the underlying healthy
Revised: December 11, 2017 cartilage, thus maintaining the normal contour of the auricle, and
Accepted: January 8, 2018 to prevent its recurrence.

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 Rao et al. 221 

MATERIALS AND METHODS the affected pinna from anterio-posteriorly by

using 3-0 Ethilon reverse cutting. The wound was
The inclusion criteria were patients of auricular bathed in mupirocin ointment. Post-procedure,
seroma visiting the OPD of ENT and Head the wound with the splint were kept open (Figure
– Neck surgery, Grant Government Medical 2). Patients received oral antibiotics and an
College, Mumbai, India. The exclusion criteria analgesic and were reviewed on every alternate
were any coexistent disease of the pinna, i.e. day for two weeks. Patients were educated to
abscess, dermatological conditions, congenital avoid trauma or soakage of the dressing and
anomalies, and any coexistent disease of the were advised to review with us immediately,
external ear or middle ear. An informed valid if they experienced excessive pain, diffuse
and written consent was taken from the patients redness, discharge or fever. The patients were
undergoing the procedure. Under strict aseptic examined for any reaccumilation, discoloration
conditions, the patients were given aural block of the pinna, deformity, thickening, or signs of
using 26G needle and 2% lignocaine and 1: perichondritis. After removal of the splint, the
100,000 adrenaline. patients were followed up for 6 months.
A cotton ball was placed in the outer EAC.
Once the patient was adequately anesthetised, RESULTS
an incision parallel to the crus of antihelix
was taken. The seroma was drained through A total of 27 patients were taken into the study,
the incision site by applying pressure over the with 24 males and 3 females. Median age group
skin, the blunt end of the Freer’s speculum was was 41.19 years, 20 patients had right sided lesion,
passed through the site of incision to break the 7 had left sided lesion, none of the patients had
septations if existed. A betadine wash was given bilateral lesions. Trauma was predisposing factor
through the wound. After adequate drainage for 4 patients (14.81%) and significant etiological
of the seroma, a corrugated rubber sheet was factor was not identifiable in other patients in
fashioned into the shape of affected pinna. In 23 patients (85.19%) (Figure 3). Following the
anterior splint, triangular cut was made into the aspiration contour dressing and splint application
anterior end of the sheet facilitating the drainage, (Figure 4), in all 27 patients (100%) there was
if there is reaccumilation. complete resolution of swelling (Figure 5). No
In posterior splint, curvilinear cut was made patients have reaccumilation of fluid in the ear. The
to accommodate into the post aural groove patients were asked to continue with the antibiotics
(Figure 1). These splints were used to sandwich and analgesics orally along topical mupirocin.

Fig. 1: The corrugated drain sheet fashioned into anterior and posterior splints. The anterior splint having
triangular cut to facilitate drainage and accommodate crus of Helix; the posterior splint having curvilinear cut to
accommodate in post-aural groove.

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222  Auricular splint in pseudocyst

Fig. 2: The pre-operative photograph (panel A) depicting extensive chronic pseudocyst of the right auricle
following trauma. Post-operative photograph with aural splint is shown in panel B.

Fig. 3: Pie chart depicting the aetiology of pseudocyst.

Fig. 4: Bar graph depicting the post-operative observations during follow up.

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 Rao et al. 223 

Fig. 5: Localized pseudocyst of right ear (panel A) and complete resolution seen during the 6th month follow up
(panel B).

Discolouration of the pinna (Figure 6 and 7) DISCUSSION

was noted at 2 weeks following the splint removal
in 9 patients (33.33%). Skin thickening over the Auricular seroma of the auricle were initially
pinna was seen in 8 patients (29.63%). The skin reported in Chinese men.1 Auricular seroma,
thickening and discolouration were managed also known as pseudocyst of the pinna, which
with topical emollients which resolved in 2 weeks. is typically unilateral, asymptomatic and cystic
Seven patients (25.93%) had residual deformities swellings predominantly in the right ear. Male
of the pinna such as loss of contour and ridging preponderance is observed. in our study, the age
of skin corresponding to the corrugated rubber of the affected patients ranged from 16 to 62
sheet (Figure 6). The skin ridging resolved in years with 24 males (87%) and 3 females (13%).
2-3 weeks without any further therapy. None of The literature suggests that the age group 15-
the patients had any major complications like 85 are affected more.2 Mostly, the cause for the
perichondritis or aural abscess. pseudocyst cannot be identified.

Fig. 6: Panel A showing the post-operative photograph and Panel B depicting the skin discolouration, thickening
of skin and ridging seen during the 6th month follow up.

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224  Auricular splint in pseudocyst

Fig. 7: Panel A showing pre-operative photograph of chronic recurrent auricular pseudocyst, Panel B showing
immediate post-operative photograph and panel C showing 6th monthly follow up photograph depicting
maintenance of good aural contour with mild skin discolouration and thickening of skin.

The differential diagnosis includes Chang et al. described a technique under

subperichondral hematoma caused by local anaesthesia consisting of de-roofing the
accumulation of blood secondary to trauma, anterior wall of the Pseudocyst after exposure
relapsing polychondritis, and cellulitis. through a skin incision along the antihelical line.
Pseudocyst commonly occur as a post trauma The anterior leaflet of cartilage was resected
sequela. Multiple hypothesis has been put forth along the circumference of the swelling and the
explaining the seroma formation such as lysosomal posterior leaflet was curetted to remove debris
degradation of cartilage which is a consequence and granulation tissue. Resuturing of the skin
of a trauma. There have been postulates which was performed to return it to its original position
suggests the gaps in the auricular cartilage, these and a compression dressing was then applied
gaps tend to open the tissue planes when subjected for two days.4 However, the invasive treatment
to repeated minor trauma or mechanical stress, modalities carry the risk of perichondritis
forming a pseudocyst.1,3 complicated by formation of a floppy ear or
In our case study, only 4 patients (14.81%) cauliflower deformity and may be followed by
had history of trauma. Several methods of recurrences.5,6
treating auricular pseudocysts are described The main disadvantage associated with
in the literature. This may be due to the high intralesional steroid administration such as
recurrence rates reported with aspiration alone. skin pigmentation changes, and cartilage
When pseudocysts do recur it is typically atrophy. Other methods were (i) Aspiration
within several weeks. So, the ideally aim of the with pressure dressing using cotton–recurrence
treatment is successful resolution of the seroma rate of 60 to 96.55%,7 (ii) Incision and drainage
without damage to the healthy cartilage, thus with buttoning-recurrence rate of 38% to 40%,7
maintaining the normal contour of the auricle, (iii) Simple aspiration followed by intralesional
and to prevent its recurrence. Many treatment steroid injection followed by pressure dressing–
modalities have been reported in the literature recurrence rate of 43%, (iv) In needle aspiration
include simple aspiration, intralesional injection with intralesional steroid injection and contour
of corticosteroids, aspiration in combination dressing - recurrence rate of 85.41%, (v) Surgical
with bolstered pressure sutures, aspiration with de-roofing of the pseudocyst–recurrence rate
cruciate incision, and application of POP cast of 10%,4,8 and (vi) Surgical de-roofing with
following drainage. buttoning, no reported recurrence.

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 Rao et al. 225 

Certain authors have been aggressive in their non-porosity of the rubber sheet. The use of
approach by excising of the anterior wall of the corrugated drain sheet splint is an ingenious
pseudocyst followed by abrasion of granulation method of aural pseudocyst management. This
tissue on the inner wall with a diamond burr, method is simple can be performed by even less
followed by a bolster dressing and two weeks experienced surgeons and highly economical
postoperatively the patient had an area of which prevents the recurrence maintains the
exposed cartilage that required a full thickness auricular aesthetics.
post auricular skin graft.9 In our study following
the aspiration, contour dressing and splint CONFLICT OF INTEREST
application, in all 27 patients (100%), there was
complete resolution of swelling. No patient had The authors declare no conflict of interest.
reaccumilation of fluid in the ear.
The method used in the study is of simple REFERENCES
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