*Fractures can also be classified relating to otic capsule involvement involvement of the otic capsule carries an increased risk of hearing loss, facial nerve palsy, and CSF leakĬlinical signs suggesting a temporal bone fracture should be assessed for, perhaps the most important of which is facial nerve injury. Transverse temporal bone fractures occur from fronto-occipital head trauma and are usually associated with sensorineural hearing loss or facial nerve injury.Longitudinal temporal bone fractures are the more common type (~80%), typically occurring from a lateral blow to the head and are usually associated with conductive hearing loss.Temporal bone fractures can be categorised* as either longitudinal or transverse (many are mixed), depending on their relation to the axis of the ear canal: CT imaging provides the initial mainstay of investigation (Fig. Patients presenting with a head injury and suspected temporal bone fracture need prompt investigation and management. *In small haematomas presenting early, one can consider simple needle aspiration, though this can carry an increased risk of incomplete haematoma evacuation This will close the perichondrial space, aiming to prevent the re-accumulation of blood and restoring cartilage perfusion. One option is to then place a dental roll either side of the auricle and secure these in place using tight mattress sutures around the rolls and through the pinna (Fig. If required, the cavity can be washed out with saline. Local anaesthetic (not containing adrenaline) should be instilled to provide a regional block of the pinna.Īn incision along the inside of the helical rim (the point where most fluctuant and least aesthetic compromise) is made, allowing for the evacuation of the haematoma*. *The main differential diagnosis is an auricular pseudocyst, which can develop spontaneously or as a result of trauma in such cases, serous fluid collects, giving a similar appearance to pinna haematomaįigure 2 – A Patient with a “Cauliflower Ear” Drainage of a Pinna HaematomaĮnsure an appropriate aseptic field is prepared (ideally performed in the operating theatre). If the haematoma re-accumulates, it will require re-drainage. The underlying cartilage becomes more susceptible to infection due to the compromised blood supply, therefore drainage of the haematoma should be performed within 24 hours of the injury.Īfter evacuation of a haematoma, gauze padding should be placed over the ear and a tight headband applied. Subsequent fibrocartilage overgrowth can lead to a structural deformity, colloquially termed ‘cauliflower ear’ (Fig. If pinna haematomas are left untreated, due to the disrupted blood supply, avascular necrosis of the pinna can occur. Consequently, the blood supply to the underlying cartilage can become impaired. Pinna haematomas are a common injury* following shearing forces applied the auricle, most commonly seen amongst rugby players and boxers.įollowing initial trauma, the perichondrial blood vessels tear, resulting in haematoma forming between the auricular cartilage and the overlying perichondrium.
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